What is a common issue with durable medical equipment (DME) in fraud schemes?

• A. DME billing is always accurate and never associated with kickbacks.
• B. Patients always want the equipment they receive.
• C. DME suppliers never have high payment error rates.
• D. Providers might submit claims for durable medical equipment for patients who do not want or need it; DME suppliers have high payment error rates and sometimes provide kickbacks to providers who refer patients.

Answer: (D)

Durable medical equipment fraud often hinges on improper financial incentives and inaccurate billing. In many schemes, providers receive kickbacks from DME suppliers in exchange for referrals, which distorts medical decision-making and drives overutilization. This can lead to claims for equipment that patients don’t want or don’t need, or to orders and deliveries that aren’t medically justified. At the same time, DME tends to have high payment error rates because of upcoding, billing for more expensive devices, or billing for items that were never furnished. The combination of kickbacks and billing errors creates a fertile ground for improper payments, making this the common, targeted pattern in DME fraud.