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Like most industries, healthcare has vendors that provide products essential to their delivery of care. Vendors for durable medical equipment, prosthetics, orthotics and supplies, also known as DMEPOS, must practice extreme caution to comply with the legal issues of this business.
Problems with fraud and abuse has kept the government and Medicare’s eye on DMEPOS suppliers. A broadly defined law governs how durable medical equipment can be used in a patient’s home for medical purposes. There are many legal concerns to consider as a supplier to healthcare. For one, an injury or illness is the only reason a person would use the item.
The Stark Law
For DMEPOS suppliers, the Stark Law is an important legal area of consideration. It was written to limit chances of financial fraud by preventing doctors from making referrals when they have a financial relationship with the healthcare entity to which a patient is referred.
The challenge is doctor referrals are the primary way suppliers acquire business. As a result, this can create legal entanglements from trying to obey the law and keep the doors open. Many of the statutes surrounding the doctor-supplier relationship is not always clear. For example, suppliers are not prohibited from stock-and-bill arrangements. However, rents charged must be of fair market value
Anti-Kickback statutes are another effort to curb fraud and waste. When investigating other violations, DMEPOS suppliers are sometimes faced with high penalties because they do not understand how to navigate these laws.
DMEPOS Suppliers Need a Compliance Plan
Laws concerning DMEPOS continue to change. One shield of protection is to have a compliance plan. Developing this type of plan provides an in-depth look at the supplier’s business practices. By taking into account individual supplier needs, policies and procedures can be implemented to ensure the supplier stays within the law.
Even if an issue arises, having this type of plan ensures the supplier can take the best approach towards making corrections. Additionally, the supplier can perform occasional self-audits to save time and expenses if something raises suspicions.
Get Audit Help from a Lawyer with DMEPOS Expertise
The widespread potential for fraud and abuse in the DMEPOS industry has led to the targeting of suppliers who are making every effort to obey the laws. Audits have become a prominent fixture for decades. Because of technological advances, devices in this industry constantly change and become more useful.
Patients who need these devices are only concerned with one thing: to get what they need for their health. Suppliers are focused on one thing: filling order requests. Staying compliant is another layer that can sometimes make it difficult to deliver the requested equipment.
Documenting everything to prove equipment requests are filling a medical necessity is extremely important. Lack of documentation, coding it incorrectly or duplicating information are some of the most frequent issues that arise during an audit.
Individualized help from an expert DMEPOS lawyer can advise suppliers on how to keep their paperwork in order. Audits can be an expensive and time-consuming undertaking. However, legal assistance can help suppliers deal with – or even avoid – going through the audit process.