Tougher enforcement, growing demand: DME suppliers face dual pressures

WASHINGTON – If it seems like the federal government is ramping up anti-fraud efforts, it’s not your imagination, says attorney Jeff Baird, chairman of the Health Care Group at Brown & Fortunato.     

In addition to more aggressive audits coming from the usual alphabet soup of the Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS) and its contractors, as well as whistleblower lawsuits filed under the False Claims Act, the White House in January launched a new Division for National Fraud Enforcement as part of the U.S. Department of Justice (DOJ). 

“The Trump administration is absolutely focusing on fraud, particularly fraud in the health care sector,” Baird said. “It’s also my opinion that Dr. (Mehmet) Oz is not a fan of the DME industry, so that’s also a driving force. I guess I refer to this as a tightening of the screws. What’s going to be interesting is, (at the same time), the demand for DME is going to increase.” 

Baird spoke with HME News recently about why there’s no “magic bullet” for providers looking to stay on top of compliance. 

HME News: What is your reaction to the new Division for National Fraud Enforcement? 

Jeff Baird: According to the information that's been published, the division is going to be separate and apart from the DOJ’s existing fraud enforcement groups (criminal and civil), which just seems strange. In announcing the (new) division, there were a number of references to the alleged fraud going on in Minnesota with the daycare centers and other types of ancillary providers, and so it seems as though this new division is something of a political reaction to what we've been reading about in the state. But it just shows the mindset, particularly of President Trump and his administration, now. 

HME: The final rule released in November – and its implementation of a new round of competitive bidding and increased accreditation requirements – also makes clear that reducing fraud is a priority. 

Baird: With regard to accreditation, it seems that the Trump administration is placing the responsibility on accrediting organizations to be the front line against fraud. That’s never been the purpose or mandate of AOs. Their goal has always been to ensure that DME suppliers comply with quality standards. With competitive bidding, it’s obvious that the sole purpose is to reduce the number of suppliers and to reduce reimbursement. 

HME: What advice can you offer DME suppliers to protect themselves? 

Baird: There’s no magic bullet. The proactive steps that a DME supplier needs to take are those that it should have been taking (all along). The company needs to be pristine in terms of documentation and claims submission. It can’t be sloppy. It would be wise for companies to conduct regular self-audits and hire an outside consultant once a year to conduct a mock audit. And this sounds self-serving, but DME suppliers need to have in their Rolodex a health care attorney who understands DME.

• Baird will team up with Andrea Stark of MiraVista for a webcast on Feb. 12 to discuss the year head in the HME industry. FMI: https://www.hmenews.com/webcasts/2026-look-ahead-for-dme-suppliers.