dme's legal issues

I wonder if a dme takes stuff out of a box from a manufacturer and charges either the goverment or private insurance for it and only delivers a partial box to the customer ,then sells the excess from the box to another customer have they gone down a slippery slope?I don't think its the same as a 7/11 breaking up a 12 pack and selling them as singles.Do they report the free supply of product on their tax reports? ps- got this thought from someone else's reply in a different post but thought it might warrant a new topic.I am not a legal mind so would love to hear any thoughts on the subject.

potholerepairman wrote:I wonder if a dme takes stuff out of a box from a manufacturer and charges either the goverment or private insurance for it and only delivers a partial box to the customer ,then sells the excess from the box to another customer have they gone down a slippery slope?I don't think its the same as a 7/11 breaking up a 12 pack and selling them as singles.Do they report the free supply of product on their tax reports? ps- got this thought from someone else's reply in a different post but thought it might warrant a new topic.I am not a legal mind so would love to hear any thoughts on the subject.

If you are not posing a hypothetical - I would suggest contacting the States Attorney Generals office for advise on how to proceed.

I know many DME advocates will say there is nothing wrong and they have good intentions. I don't think it is good business practice, myself.

I'm no attorney - but - it would seem to me IF say a mask is sold ONLY w/the mask itself and say 3 sizes of pillows - and the local DME provider elects to sell you the mask itself and only one size of pillows and retain the other two size pillows - that would be illegal. HOWEVER, one must be sure that that mask is not also sold as one mask and one set of pillows. There may be more than one way to purchase that mask.

We see online DME suppliers selling xPAPs complete with hose, carry case, filters as one unit. However, local DME suppliers are legally allowed to sell the hose and filters as separate "units" and the device and carry case as only one "unit".

Keep in mind that insurances pay for new cushions for a mask you have on hand and that they pay for a new mask for the headgear you have on hand so it "could" possibly be legal for them to sell a mask packaged w/3 sizes of pillows w/only one set of pillows, just as they can legally bill for a mask and headgear separately even tho they purchase the mask and headgear as one unit.

I'm not sure if it is illegal but it's certainly leaning towards unethical depending on exactly the circumstances in question.

I'm assuming your question is more to exactly what you said - buying a single complete item, taking parts off of it and then still selling the first product as a complete item and also selling the parts taken off of it.

This would be different from how many insurance companies work which is to require a provider to break down the billing on something like a mask where they require the DME to use 1 code for a mask, 1 code for the headgear and maybe 1 code for the seal. Or how they might require the CPAP itself to be billed with one code for the machine, 1 code for the hose, 1 code for the filters, etc. That's usually going to be mandated by the contract the insurance company requires the DME to go by.

mattman wrote: This would be different from how many insurance companies work which is to require a provider to break down the billing on something like a mask where they require the DME to use 1 code for a mask, 1 code for the headgear and maybe 1 code for the seal.

Here is how The Big A charges for a mask. What's wrong w/this picture????

thanks for the input all. It was a machine that someone got that they knew came with a hose and it was removed from the box before he got it that got me to think how many times the different sized pillows don't arrive in the posts that I read here that got me wondering.My dme actually gave me the free hose on top the one one they sold me .Have seen lots of post where people don't want to burden their insurance companies with frivalous dme charges and thought that medicare is everyone's money so why should a dme be able to double charge the goverment for product.In my mind its unethical but not sure ifs its illegal.If someone takes something out of the package they say they ordered straight from a company for you , not from stock it kinda makes my skin crawl .

Slinky wrote:We see online DME suppliers selling xPAPs complete with hose, carry case, filters as one unit. However, local DME suppliers are legally allowed to sell the hose and filters as separate "units" and the device and carry case as only one "unit".

Because the DME is required to bill separately for each itme are you assuming it is also legal to separate items?

Again, I think the best source of advice would be the State's Attorney General, he works for you.

I don't argue w/you at all, Gumby, about the state Attorney General's office being the best source of correct info. I was just throwing out some thoughts of possibilities. Another good source is your state legislator as they have access to and make use of a legal staff. I've gotten legal opinions (not binding) from them before.

potholerepairman wrote:thanks for the input all. It was a machine that someone got that they knew came with a hose and it was removed from the box before he got it that got me to think how many times the different sized pillows don't arrive in the posts that I read here that got me wondering.My dme actually gave me the free hose on top the one one they sold me .Have seen lots of post where people don't want to burden their insurance companies with frivalous dme charges and thought that medicare is everyone's money so why should a dme be able to double charge the goverment for product.In my mind its unethical but not sure ifs its illegal.If someone takes something out of the package they say they ordered straight from a company for you , not from stock it kinda makes my skin crawl .

I would definately tell that person to contact the provider to ask for the hose. It's just as likely as anything else that they may have forgotten to put it back in the box.

Almost all companies have to tag items and I can't actually see a case where any of them can't so this should hold true for anyone but it might not. Before a CPAP can be put out they have to be taken out, a company serial number attached, both the company and mfr serial numbers recorded, the machine tested and logged and then everything gets put back together. I know from experience there have been times when stupid items accidentally get left out. Yes I've driven all the way out to someones house before and realized I stupidly forgot to put the power cord back in a box!

So yeah, it might just be a simple mistake. That's why I suggest the phone call. Will be a quick way to find out if it was just a simple mistake or if they were trying to maliciously cheat someone out of legitamately purchased items.

I just realized that this was the thread that I meant to post the links I found this morning......instead of the following one.
So, I'm going to post the link to that thread. This is the first of the three posts I made there.

viewtopic.php?f=1&t=46053&p=413687#p413687

Sorry if this causes any confusion as both threads were discussing DME issues.


Den