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NICB Report On Durable Medical Equipment Fraud
Date:1/30/2013

DES PLAINES, Ill., Jan. 30, 2013 /PRNewswire-USNewswire/ -- The National Insurance Crime Bureau (NICB) today released a ForeCASTSM analysis that examines the impact of fraud associated with durable medical equipment (DME).  For example, on Jan. 16, 2013, Uche Ben Odunzeh, 32, of Laurel, Md., was sentenced to 19 months in federal prison.  He pled guilty to submitting more than $600,000 in false DME billings.  This included billing the government for more expensive DME while delivering less expensive items to recipients.  He also admitted to submitting numerous claims to the District of Columbia Medicaid program for DME items that he never provided to Medicaid recipients. 

The report examines questionable claims (QC) referred to NICB during the period from Jan. 1, 2009, through June 30, 2012.

QCs are claims that NICB member insurance companies refer to NICB for closer review and investigation based on one or more indicators of possible fraud.  A single claim may contain up to seven referral reasons. DME QCs have increased consistently since 2009 with New York (611), Michigan (366), California (63), and Florida (54) posting the most of all the states.

DME Overview

DME, also referred to as Durable Medical Equipment Prosthetics & Orthotics (DMEPOS), home care products, home health equipment/supplies and/or durable medical supplies, is defined as equipment that:

A. can withstand repeated use;
B. is primarily and customarily used to serve a medical purpose;
C. generally is not useful to a person in the absence of an illness or injury; and,
D. is appropriate for use in the home.

All requirements of the definition must be met before an item can be considered DME.  
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SOURCE National Insurance Crime Bureau
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