Why DME is heavily scrutinized
Medicare pays for wheelchairs, oxygen, CPAP devices, orthotics, and other equipment through suppliers who certify medical necessity and patient eligibility. High volume and decentralized ordering make DME a chronic fraud target.
Common schemes
Shipping equipment never requested, billing for upgrades not provided, paying kickbacks to physicians for signed orders, and falsifying documentation for medically unnecessary items appear frequently in OIG reports and FCA cases.
Insiders with key knowledge
Sales reps, intake staff, billing coders, and physicians pressured to sign blank orders often see whether medical necessity reviews are real or rubber-stamps.
Reporting and qui tam
Tips to NSC or OIG may trigger audits. Large systematic schemes may support sealed qui tam cases. Move promptly because of first-to-file rules. This guide is educational, not legal advice.