The whistleblower lawyers at Mahany Law are investigating a report of Medicare fraud allegedly committed by Miami based MB Ortho Services Corp.
Recently we received a report that MB Ortho is billing Medicare for medically unnecessary services and supplies. Mistakes sometimes happen so we are being careful to not to draw any conclusions. We do need your help, however, in determining if other patients are having similar problems.
What we Know About MB Ortho Services
A patient reports that MB Ortho Services is providing durable medical equipment and services that are medically unnecessary and / or not even ordered.
Durable Medical Equipment and Medicare
If you need durable medical equipment (“DME”) in your home, a doctor or nurse practitioner must prescribe the type of equipment needed. Without a prescription, it won’t be covered by Medicare and probably not by private insurance companies either. Depending on the equipment, a doctor may be required to submit additional documentation to demonstrate the equipment is medically necessary.
Common covered equipment includes:
- Air purifiers
- Blood sugar monitors and test strips
- Canes, crutches and walkers
- Commode chairs
- Continuous Positive Airway Pressure (CPAP) devices
- Hospital beds
- Infusion pumps & supplies
- Knee, shoulder, wrist and back braces
- Nebulizers & nebulizer medications
- Oxygen equipment & accessories
- Patient lifts
- Pressure-reducing beds, mattresses, and mattress overlays
- Suction pumps
- Traction equipment
- Wheelchairs and scooters
Common Medical Equipment Medicare Scams
In recent years, there has been a tremendous upswing in the number of Medicare fraud schemes involving durable medical equipment. Common scams include:
- Billing for equipment that is not medically necessary
- Billing for equipment never provided
- Paying patients to submit phony claims (kickbacks)
- Forgiving Medicare Part B co-pays (a form of kickback)
- Paying physicians to write fraudulent prescriptions (kickbacks)
- Forging prescriptions
- Stealing Medicare billing information in order to submit false claims
- Billing for more expensive items than those shipped to the patient
- Knowingly providing defective equipment
The Miami Dade County area of Florida is considered to have one of the highest rates of Medicaid and Medicare fraud in the United States. Schemes involving durable medical equipment are one of the most frequent ways that crooks today take advantage of taxpayer funded healthcare. So what happens when someone tells you that a medical equipment company based in Miami is falsely billing Medicare for medically unnecessary services? You investigate and that is what we are doing.
As noted above, the patient reports that MB Ortho Services billed his Medicare account for products and services never ordered. (The company lists its address as MB Ortho Services, 11398 W Flagler Street in Miami, Florida. Its principal is Manuel Piloto.) As part of our investigation, we are hoping to hear from other patients and especially, employees (former or present) of the company. Patient recruiters or telemarketers that may be associated with the company are welcome to call too.
Notable DME Medicare Fraud Cases
In April 2019, the Justice Department announced it had indicted 24 people in connection with a massive durable medical equipment fraud scheme. Those indicted included the owners of dozens of DME companies, several people associated with five telemedicine companies and three licensed medical professionals. (Equipment suppliers often team up with telemedicine providers to write prescriptions for medical equipment even though those providers have never treated or met the patient other than a 30 second interview via a phone app.)
Justice officials say the group is responsible for $1.2 billion in losses.
Many of those charged were alleged to have paid or received illegal kickbacks and bribes. The equipment suppliers would pay the kickbacks in return for prescriptions for medically unnecessary equipment. Several of the companies were using high pressure telemarketers to lure unsuspecting patients into providing their insurance information.
In announcing the indictments, a Justice Department spokesperson said, “These defendants — who range from corporate executives to medical professionals — allegedly participated in an expansive and sophisticated fraud to exploit telemedicine technology meant for patients otherwise unable to access health care.”
Previously, we announced our investigation against National Seating & Mobility for a similar scam. (If you want to see a funny video of a high pressure ad campaign by the Scooter Store, visit the above post.)
In addition to the criminal charges, Medicare took administrative action against 130 medical equipment companies that allegedly submitted $1.7 million in claims.
Is MB Ortho Services doing anything illegal? We simply don’t know. Hopefully a present or former employee or more patients will contact us. A single patient can’t establish a “pattern or practice” of fraud but an employee or several patients with similar stories can.
Although this post concerns MB ortho, we are interested in speaking with anyone that has information about DME fraud. That includes telemarketers. (Even offshore telemarketers are eligible for rewards. You do not have to be a U.S. citizen.)
Medical Equipment Whistleblowers Earn Cash Rewards
Why should folks step forward and report Medicare fraud? The answers are many.
First, it’s the right thing to do. Healthcare whistleblowers are the new American heroes. By stepping forward, they help fight greed and corruption and level the playing field for honest companies.
Whistleblowers also save taxpayers billions of dollars in taxes each year. (The federal False Claims Act whistleblower law collected $3 billion for the government in 2019.)
Need more reasons? Whistleblowers are entitled to between 15% and 30% of whatever the government collects from wrongdoers. Multi-million dollar rewards are not uncommon.
Whistleblowers are also protected from retaliation. Employers who retaliate against whistleblowers can be forced to pay lost wages, double damages, legal fees and costs of investigation.
Finally, in many healthcare cases, Medicare fraud whistleblowers save lives. Common examples are nurses and billing clerks who report doctors who are using cheaper, non-FDA approved cancer drugs and doctors who are performing medically unnecessary cardiac stent procedures.
All inquiries are protected by the attorney – client privilege. We accept cases anywhere in the United States including Puerto Rico.