The term “durable medical equipment” refers to any type of medical equipment that is used in the home in order to aid in a better quality of living. Also referred to as “DME”, such equipment can include iron lungs, oxygen tents, Nebulizers, CPAP, catheters, hospital beds and wheelchairs. Many insurance policies cover durable medical equipment. Medicare and Medicaid are also known for offering DME coverage.
Genetic testing for cancer refers to lab tests that are conducted on cells taken from the human body. Often, the tests require samples of blood, saliva and/or the swabbing of cheek cells from inside the mouth. No genetic test can be 100% accurate in determining whether or not a patient has cancer. However, they are considered reliable in being able to determine if a person is at a higher risk of developing such cancers as breast, ovarian, colon, thyroid and prostate.
A Texas doctor is guilty of fraudulent DME and cancer genetic testing billings.
As reported by the United States Department of Justice yesterday, a Texas doctor has pleaded guilty to a $54 million Medicare scam. 49 year-old Daniel R. Canchola prescribed durable medical equipment and cancer genetic testing without ever seeing, speaking to or otherwise treating patients.
According to court documents, the Flower Mound, Texas resident agreed to electronically sign orders for DME and cancer genetic testing. He knew the orders were used to submit more than $54 million in false and fraudulent claims to Medicare. Between August 2018 and April 2019, Canchola received about $30 in exchange for each doctor’s order he signed.
The orders were illegitimate.
Each of the orders signed by Canchola authorized DME and cancer genetic test orders. However, they were not legitimately prescribed, not needed, or not used. Through these fraudulent orders, Canchola earned over $466,000 in kickbacks. The Medicare beneficiaries for whom Canchola prescribed DME and cancer genetic testing were targeted by telemarketing campaigns. They were also propositioned at health fairs.
The beneficiaries were induced to submit to the cancer genetic testing and to receive the DME regardless of medical necessity. “Canchola pleaded guilty to conspiracy to commit wire fraud,” confirms the DoJ, “He is scheduled to be sentenced on March 15, 2023, and faces a maximum penalty of 20 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.”
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