Durable medical equipment (DME) plays a critical role in the healthcare industry, helping patients manage chronic conditions and recover from illnesses or injuries. However, the high demand for these products and the involvement of multiple parties in the sales and billing process create opportunities for fraud.
While business owners and healthcare providers are often the primary focus of DME fraud investigations, sales representatives can also face serious legal consequences. If you’re a sales representative in the DME industry, understanding your legal responsibilities and how liability is determined is essential for protecting yourself from potential fraud charges. We can help.
Established in 1977, Trombley & Hanes, P.A. has built a reputation for delivering comprehensive legal defense solutions to individuals and businesses facing state and federal charges across Florida and the United States.
What is Durable Medical Equipment Fraud?
DME fraud typically involves the submission of false claims to government healthcare programs like Medicare and Medicaid.
Sales representatives are often intermediaries between DME providers and healthcare professionals, making them potential targets in fraud investigations if their actions contribute to fraudulent activities.
How Can a Sales Representative Be Held Liable?
Sales representatives may face liability for DME fraud if their actions intentionally or negligently contribute to fraudulent claims.
Some scenarios where a sales representative could be implicated include:
- Participating in Kickback Schemes: A sales representative who pays or receives illegal kickbacks to secure business may violate the federal Anti-Kickback Statute. This law prohibits offering, paying, soliciting, or receiving remuneration in exchange for referrals of items or services covered by federal healthcare programs.
- Falsifying Documentation: Creating or knowingly using falsified documents, such as fake prescriptions or patient records, can result in fraud charges. Even if the representative is not directly involved in billing, their participation in falsifying records can implicate them in the larger scheme.
- Promoting Unnecessary Equipment: Encouraging physicians or healthcare providers to prescribe equipment patients do not need to generate sales could expose a sales representative to liability.
- Willful Ignorance: Turning a blind eye to fraudulent activities within their organization or among their clients does not absolve a sales representative of responsibility. The law often considers “willful ignorance” as complicity.
Penalties for Involvement in DME Fraud
Sales representatives found guilty of participating in DME fraud can face severe consequences, including:
- Civil penalties, such as fines under the False Claims Act.
- Criminal charges leading to imprisonment, especially for violations of the Anti-Kickback Statute or conspiracy to commit healthcare fraud.
- Career damage and loss of professional licenses.
How to Protect Yourself
If you are a sales representative in the DME industry, here are steps to safeguard yourself from liability:
- Know the Law: Familiarize yourself with federal regulations, including the Anti-Kickback Statute and the Stark Law.
- Document Everything: Keep detailed records of your transactions, communications, and practices to demonstrate compliance with legal standards.
- Report Concerns: If you suspect fraud within your organization, report it to your compliance officer or legal team. Whistleblower protections may apply.
- Seek Legal Advice: Consult with an attorney if you are unsure whether certain practices might expose you to liability.
Contact Trombley & Hanes for Help
If you’re a sales representative facing allegations of DME fraud, the consequences can be life-altering. At Trombley & Hanes, our experienced Florida criminal and civil litigators understand the complexities of these cases and are dedicated to protecting your rights and reputation. Contact us at 813-229-7918 or online to discuss your case and develop a robust defense strategy.
