Federal Register: January 14, 2010 (Volume 75, Number 9)
DOCID: fr14ja10-19 FR Doc 2010-562
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Inspector General Office, Health and Human Services Department
NOTICE: NOTICES
DOCID: fr14ja10-19
DOCUMENT ACTION: Notice.
SUBJECT CATEGORY:
Publication of OIG Updated Special Fraud Alert on Telemarketing by Durable Medical Equipment Suppliers
DOCUMENT SUMMARY:
This Federal Register notice sets forth the recently issued OIG Updated Special Fraud Alert addressing telemarketing by durable medical equipment (DME) suppliers. For the most part, OIG Special Fraud Alerts address national trends in health care fraud, including potential violations of the antikickback statute for Federal health care programs. This Updated Special Fraud Alert updates the Special Fraud Alert on Telemarketing by Durable Medical Equipment Suppliers originally issued in March 2003 and continues to highlight the statutory provision prohibiting DME suppliers from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item.
SUMMARY:
Updated Special Fraud Alert on Telemarketing by Durable Medical Equipment Suppliers
SUPPLEMENTAL INFORMATION
I. Background
The Office of Inspector General (OIG) was established at the Department of Health and Human Services by Congress in 1976 to identify and eliminate fraud, waste, and abuse in the Department's programs and to promote efficiency and economy in departmental operations. OIG carries out this mission through a nationwide program of audits, investigations, and inspections. To reduce fraud and abuse in the Federal health care programs, including Medicare and Medicaid, OIG actively investigates fraudulent schemes that are used to obtain money from these programs and, when appropriate, issues Special Fraud Alerts that identify practices in the health care industry that are particularly vulnerable to abuse.
OIG issues Special Fraud Alerts based on information it obtains
concerning particular fraudulent or abusive practices within the health
care industry. Special Fraud Alerts are intended for widespread
dissemination to the health care provider community, as well as those
charged with administering the Medicare and Medicaid programs. To date,
OIG has published in the Federal Register the texts of 12 previously issued Special Fraud Alerts.\1\
\1\ All OIG Special Fraud Alerts are available on the OIG Web
site at: http://oig.hhs.gov/fraud/fraudalerts.asp.
This Updated Special Fraud Alert updates the Special Fraud Alert on
Telemarketing by Durable Medical Equipment Suppliers originally issued
in March 2003 and continues to focus on section 1834(a)(17) of the
Social Security Act, which prohibits suppliers of DME, except under
limited circumstances, from making unsolicited telephone calls to
Medicare beneficiaries regarding the furnishing of a covered item, and
possible telemarketing practices by DME suppliers through the use of independent marketing firms.
II. Updated Special Fraud Alert: Telemarketing by Durable Medical
Equipment Suppliers (November 2009; Original Published March 2003)
Section 1834(a)(17)(A) of the Social Security Act prohibits suppliers of durable medical equipment (DME) from making unsolicited telephone calls to Medicare beneficiaries regarding the furnishing of a covered item, except in three specific situations: (i) The beneficiary has given written permission to the supplier to make contact by telephone; (ii) the contact is regarding a covered item that the supplier has already furnished the beneficiary; or (iii) the supplier has furnished at least one covered item to the beneficiary during the preceding 15 months. Section 1834(a)(17)(B) specifically prohibits payment to a supplier that knowingly submits a claim generated pursuant to a prohibited telephone solicitation. Accordingly, such claims for payment are false and violators are potentially subject to criminal, civil, and administrative penalties, including exclusion from Federal health care programs.
The Office of Inspector General (OIG) has received credible information that some DME suppliers continue to use independent marketing firms to make unsolicited telephone calls to Medicare beneficiaries to market DME, notwithstanding the clear statutory prohibition. Suppliers cannot do indirectly that which they are prohibited from doing directly. OIG has also been made aware of instances when DME suppliers, notwithstanding the clear statutory prohibition, contact Medicare beneficiaries by telephone based solely on treating physicians' preliminary written or verbal orders prescribing DME for the beneficiaries. A physician's preliminary written or verbal order is not a substitute for the requisite written consent of a Medicare beneficiary.
Except in the three specific circumstances described in the
statute, section 1834(a)(17)(A) prohibits unsolicited telemarketing by
a DME supplier to Medicare beneficiaries, whether contact with a
beneficiary is made by the supplier directly or by another party on the
DME supplier's behalf. Moreover, a DME supplier is responsible for
verifying that marketing activities performed by third parties with
which the supplier contracts or otherwise does business do not involve
prohibited activity and that information purchased from such third
parties was neither obtained, nor derived, from prohibited activity. If
a claim for payment is submitted for items or services generated by a
prohibited solicitation, both the DME supplier and the telemarketer are
potentially liable for criminal, civil, and administrative penalties
for causing the filing of a false claim, as well as criminal and civil
penalties for using interstate telephone calls in furtherance of schemes to defraud.
What To Do If You Have Information About Fraud and Abuse Involving Medicare or Medicaid Programs
If you have information about DME suppliers or telemarketers
engaging in any of the activities described above, contact any of the regional offices of OIG, U.S. Department of Health and
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Human Services, at the following locations:
Regional offices States served Telephone
Boston.................................. MA, CT, ME, NH, RI, VT......... 6175652664
New York................................ NY, NJ, PR, VI................. 2122641691
Philadelphia............................ PA, DE, DC, MD, VA, WV......... 2158614586
Atlanta................................. AL, GA, KY, NC, SC, TN, MS..... 4045627603
Chicago................................. IL, IN, MI, MN, OH, WI......... 3123532740
Dallas.................................. TX, LA, AR, OK, NM............. 2147678406
Kansas City............................. MO, ND, SD, MT, KS, IA, CO, NE, 8164264000 UT, WY.
San Francisco........................... No. CA, OR, WA, ID, AK......... 4154377961
Los Angeles............................. So. CA, AZ, NV, HI............. 7142468302
Miami................................... FL............................. 3055307756
Dated: December 14, 2009.
Daniel R. Levinson,
Inspector General.
[FR Doc. 2010562 Filed 11310; 8:45 am]
BILLING CODE 415201P
FOR FURTHER INFORMATION CONTACT
James A. Cannatti III, Senior Counsel, Office of Counsel to the Inspector General, (202) 2050007.