Directions: Complete the Problem on page 579 of the text as a three to four page

Question

Directions: Complete the Problem on page 579 of the text as a three to four page paper. For a general description of Marcus Welby Hospital see page 369 of the text.

You are outside counsel to the Marcus Welby Healthcare Corporation, which among its other operations owns a durable medical equipment (DME) subsidiary, which sells equipment for home use such as crutches, wheelchairs, and oxygen concentrators. You learn that the subsidiary has had certain business practices about which you have some question under the Medicare and Medicaid Anti-Fraud and Abuse provisions:

• Salesmen regularly offer home health agency employees a “premium” whenever their clients order DME from the subsidiary.
• The subsidiary offers “rebates” to patients who use its equipment.
• The subsidiary pays hospital and home health agency personnel for assisting its patients in learning how to use its products.
• Some arterial blood gas test results may have been “massaged a bit” by the DME in order to facilitate Medicare payment for oxygen concentrators.

What advice would you give?

Explanation / Answer

Durable medical equipment (DME) and medical supplies are need in the hospitals and even at home.

Whenever medically needed they will purchase reasonable, cost effective Medicaid. So we need identify the right patient, right equipment and right delivery with the approval.

Being a counsel I will give advises to improve billing, prevent unintended consequences (fraud and misconduct), and helps strengthen the integrity of the Medicaid Program by ensuring you meet Medicaid requirements and your patients receive medically necessary DME:

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