Settlements reached with DME suppliers
The OIG's Provider Investigations unit investigates and reviews allegations of fraud, waste and abuse involving Medicaid providers. Based on an investigation's findings, OIG actions can include education, prepayment review of claims, penalties, required repayment of Medicaid overpayments and/or exclusion from the Medicaid program. Among the results for Provider Investigations cases settled by Litigation for the third quarter were several involving durable medical equipment suppliers (DMEs).
The OIG settled a case against an Austin-based durable medical equipment supplier that is one of the largest in the state. The investigation found evidence supporting one or more alleged program violations consistent with missing and insufficient doctor authorization. The provider agreed to a settlement of $103,845. An investigation of a DME supplier’s billing between 2014 and 2018 found claims for supplies that were not supported by inventory records and never provided to clients, and billed for items missing a doctor’s authorization; the provider in Mission agreed to a settlement of $349,963. A case that was transferred from the Texas Medicaid Fraud Control Unit involved a DME supplier in Hidalgo County. An inventory analysis revealed that the provider did not purchase sufficient supplies to justify their claims submitted to Medicaid. The provider worked collaboratively with OIG Litigation to resolve these issues and agreed to a settlement of $120,000.