Frank Margulis: Don't make my mistakes

Wednesday, September 30, 2009

Like most HME providers, Frank Margulis thought he understood the rules. Then he was charged with obstructing a Medicare audit. In 2005, he was sentenced to five months in a federal prison camp and five months of house arrest. Now a free man, Margulis will share his story during his Medtrade session, "Avoiding Legal Landmines: Lessons Learned the Hard Way."

HME News: What was the basis of the lawsuit?

Frank Margulis: When we gathered CMNs for a routine audit, we noticed that only the first line items printed out. The base of the power wheelchair was there, but accessories, like batteries, were not.  I didn't feel like sending in a corrected CMN to the doctor and then sending it back to Medicare, so I wrote in the accessories. I reasoned that it wouldn't be a big deal.

HME: What caught you most off-guard about the lawsuit against you?

Margulis: It's not that we billed for stuff we didn't supply. But I didn't follow procedure. There was some arrogance involved.

HME: Do you think most providers are like you--surprised to find themselves being sued?

Margulis: I don't think there's an intent to commit fraud. Sometimes we can't keep up with the rules or we don't want to because they are such a burden.

HME: What lessons did you learn, as a result of the lawsuit?

Margulis: I was lax in my oversight. One of my stores was located 70 miles away so I went there about five times a year. That store manager actually did commit fraud and nobody knew anything about it.

HME: What is one area that providers need to examine more carefully?

Margulis: Owners and managers tend to hole up in their offices, but they'd better get up and walk around now and then. I implemented weekly staff meetings and there was a lot more accountability.

HME: If providers take away one thing from your session, what should it be?

Margulis: They need to make time to evaluate their organizations. If there are any weak spots, they better address them.