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In the field of healthcare providers, those who provide durable medical equipment, prosthetics, orthotics and supplies need to be especially careful of legal issues surrounding their business. The law defines DMEPOS broadly, and the definition includes any durable medical equipment that can be used in the home for a medical purpose by a person who would not otherwise need the item if not for injury or illness. There are plenty of legal areas of concern that DMEPOS suppliers should be aware of, and hiring the right firm can ensure suppliers conduct their business according to the law.
The government and Medicare has been keeping a close eye on DMEPOS suppliers for years, citing the potential for fraud and other abuses that may be present in the field. Lawyers for suppliers advise their clients on a variety of issues within this area.
The Stark Law is one of the most important areas of consideration for DMEPOS suppliers. It seeks to limit financial fraud by prohibiting physicians from making referrals when the physician has a financial relationship of any kind with the healthcare entity the patient has been referred to.
However, physician referrals are the primary way that many DMEPOS suppliers drive their business. Attorneys can advise clients on navigating the Stark Law to avoid legal entanglements. The physician-supplier relationship statutes are complex and not always clear. For example, the Stark Law does not prohibit stock-and-bill arrangements, but the rents charged under these arrangements must be considered fair-market value and lawyers can offer expertise on how to properly document arrangements like these.
The Stark law is not the only anti-kickback law in effect. In an effort to curb instances of fraud and waste, the government and FCA prosecutors are investigating other violations of these complicated statutes, and many DMEPOS suppliers find themselves facing high penalties for failing to understand how to navigate these laws. Clients can utilize attorney expertise to better understand the implications of these statutes and avoid penalties in the future.
As the laws surrounding DMEPOS continue to change and new rules phase in, one benefit that lawyers can offer their clients is a compliance plan that takes an in-depth look at the supplier’s business. This compliance plan takes into account the individual supplier’s needs and outlines the policies and procedures needed to stay within the law. Having a plan like this in place can even allow companies the ability to self-audit, which will save them time and expenses in the long run.
Because of the widespread potential in the DME industry for fraud and other abuses, DMEPOS suppliers have been targeted by audits over the last several decades. Technological advances have made the DME market one that is always changing as devices become more useful for those needing them, and this can also create difficulties with staying compliant. Because durable medical equipment needs to be medically necessary, it is important that suppliers document everything. Lack of documentation, or documentation that is filed incorrectly, duplicated, coded wrong or incomplete are some of the most frequent issues cited by Medicare during their audits.
Lawyers can advise on other areas of concern specific to a client’s business model and work with the supplier to ensure that everything is correctly documented. Audits are an expensive and time-consuming process, but attorneys with DMEPOS expertise can help clients successfully deal with them.
Due to the myriad of statutes enforced in the field of DMEPOS, other areas of expertise may be needed. These include the following topics.
It is clear that DMEPOS suppliers play an important role in the field of health care management. Their products are vital to the quality of life for many patients, and advances in device technology has led to ever-changing issues that both suppliers and regulators face in this field. As DMEPOS suppliers seek to navigate the complex web of statutes and regulations they must adhere to, attorneys can help their clients avoid potential pitfalls.