DME Fraud Attorney

Durable medical equipment fraud, known as DME fraud, is one of the most aggressively prosecuted areas of healthcare fraud in the country, and a federal DME fraud conviction can carry up to 10 years in prison per count, along with enormous restitution, forfeiture, and exclusion from Medicare and Medicaid. The government has brought sweeping cases against DME companies, owners, marketers, and the physicians who signed orders, often built around telemarketing and telemedicine schemes for braces, orthotics, and other equipment. Because these cases turn on proving intent and medical necessity, they are frequently defensible, but only with the right lawyer and an early start. If you or your company is under investigation in New York City, an experienced DME fraud attorney should be your first call.

Varghese & Associates, P.C. is a federal criminal defense firm on Wall Street, in the heart of the Southern District of New York. DME fraud defense is a core part of our healthcare fraud defense practice, and the firm is led by Vinoo Varghese, a former prosecutor and one of the most recognized criminal defense attorneys in the country. Our DME fraud attorneys handle these matters in house, from the first audit or subpoena through investigation, indictment, trial, sentencing, and appeal. Matters are not routed out to other firms.

Call now for a confidential consultation with a New York City DME fraud lawyer. The earlier our DME fraud defense lawyers are involved, the more they can do.

What Is DME Fraud?

DME fraud is a type of healthcare fraud that involves billing Medicare, Medicaid, or another insurer for durable medical equipment, such as wheelchairs, braces, orthotics, or CPAP machines, that was not provided, was not medically necessary, or was obtained through kickbacks. Durable medical equipment is reusable medical equipment prescribed for use at home, and it is a frequent fraud target because it can be billed in high volume. The defining element of a DME fraud charge is intent, meaning the government must prove a knowing scheme to defraud, not a billing error or a good-faith belief that equipment was needed. That intent requirement is where an experienced DME fraud attorney concentrates the defense.

What Are Examples of DME Fraud?

Common examples of DME fraud include billing for equipment that was never delivered, billing for medically unnecessary equipment, paying or receiving kickbacks for orders or referrals, using telemarketing or telemedicine to generate orders, upcoding to more expensive items, and forging or obtaining physician signatures on orders. Many recent federal cases center on nationwide schemes in which call centers and telemedicine companies generated orders for orthotic braces that patients did not need, with kickbacks paid up and down the chain. In practice, DME fraud is rarely charged alone, and prosecutors frequently pair it with the Anti-Kickback Statute, conspiracy, and money laundering, stacking counts to increase both the pressure and the potential sentence.

Who Does the Government Investigate for DME Fraud?

The government investigates DME company owners and executives, DME suppliers, marketers and telemarketing companies, telemedicine platforms, and the physicians and other practitioners who signed the orders. These cases are built by the FBI, HHS-OIG, and DOJ healthcare fraud strike forces, often using billing-data analytics and cooperating insiders. A person can be pulled into a DME case simply for signing orders or for a marketing arrangement the government later characterizes as a kickback. Because exposure can reach many participants who did not see the full picture, early and independent defense is critical.

DME Fraud and the Statutes Behind It

DME fraud is charged under the federal healthcare fraud statutes, and prosecutors often use several at once. The charges most often in play include:

• Healthcare fraud (18 U.S.C. § 1347)
• Federal Anti-Kickback Statute, for paying or receiving value for orders or referrals (42 U.S.C. § 1320a-7b(b))
• False statements relating to healthcare matters (18 U.S.C. § 1035)
• Conspiracy to commit healthcare fraud (18 U.S.C. § 1349)
• The civil False Claims Act, which often runs alongside a criminal case (31 U.S.C. §§ 3729 through 3733)
• Money laundering of the alleged proceeds (18 U.S.C. §§ 1956 and 1957)

Why Are Kickbacks Central to DME Fraud Cases?

Kickbacks are central to many DME fraud cases because the government treats payments for patient referrals, orders, or leads as illegal under the Anti-Kickback Statute, and it uses those payments to tie marketers, telemedicine companies, and DME suppliers together into a single scheme. Arrangements that the parties viewed as legitimate marketing, consulting, or lead-generation fees are often recharacterized by prosecutors as kickbacks. Because the Anti-Kickback Statute is broad and technical, and because it has safe harbors and good-faith limits, whether a payment was actually an illegal kickback is frequently the central battleground, and it is where our DME fraud attorneys focus.

What Are the Penalties for DME Fraud?

DME fraud charged as healthcare fraud carries up to 10 years in prison per count, up to 20 years if a patient suffered serious bodily injury, and Anti-Kickback violations add up to 10 years per count, along with heavy fines, restitution, forfeiture, and exclusion from Medicare and Medicaid. Because each claim or transaction can be charged as a separate count, exposure can multiply quickly, and the civil False Claims Act can add treble damages on top. For a DME business, exclusion from federal programs is itself a fatal blow. The severity of these consequences is exactly why an experienced DME fraud attorney should be involved as early as possible.

How Does Sentencing Work in a DME Fraud Case?

Federal DME fraud sentences are calculated under the United States Sentencing Guidelines, where the single biggest driver is the intended or actual loss, meaning the amount the government says was fraudulently billed. Prosecutors often calculate loss by treating every claim as fraudulent, which dramatically overstates the number. One of the most valuable fights in a DME fraud case is challenging that loss figure, including the government's sampling and extrapolation methods, and separating legitimate billing from what is alleged to be fraudulent. Our DME fraud attorneys contest the loss calculation, challenge enhancements, present detailed mitigation, and argue for a sentence below the guideline range.

What Are the Defenses to a DME Fraud Charge?

DME fraud turns on intent and medical necessity, and that is where the defenses concentrate. Every case is different, but the strategies our DME fraud lawyers commonly use include:

• No intent to defraud. Billing errors, coding mistakes, and good-faith reliance on orders are not crimes.
• Medical necessity. Showing the equipment was appropriate and supported by a valid physician order.
• Legitimate business arrangement. Demonstrating that a marketing, consulting, or lead arrangement was lawful rather than a kickback.
• Good-faith reliance. Reasonable reliance on physicians, billing staff, or compliance advice can negate the required intent.
• Attacking the loss and extrapolation. Challenging the government's sampling and damages methods, which often overstate the loss.
• Suppression. Where records were obtained through an unlawful search or subpoena, moving to suppress under the Fourth Amendment.

What Should You Do If You Are Under Investigation for DME Fraud?

If you learn you are under investigation for DME fraud, or receive an audit letter, subpoena, or visit from agents, do not talk to investigators, do not turn over records without counsel, and do not alter or destroy any documents. Call a DME fraud attorney immediately. Anything you say can be used against you, and altering records after an investigation begins can create a separate obstruction charge. You have the right to remain silent and the right to counsel. Preserve everything, say nothing without counsel, and let your lawyer engage the auditors and prosecutors.

How Our DME Fraud Attorneys Can Help You

Our DME fraud defense lawyers defend these matters at every stage, and they look for the earliest possible point at which the case can be won or shrunk:

• Early intervention. Responding to audits, subpoenas, and target letters to keep a matter civil where possible and to negotiate a declination or reduced charges before an indictment.
• Attacking the kickback theory. Building the case that a marketing or referral arrangement was legitimate rather than an illegal kickback.
• Fighting the loss and extrapolation. Using forensic experts to challenge the government's damages and sampling methods.
• Motion practice and trial. Moving to dismiss defective counts, suppressing unlawfully obtained evidence, and trying cases before federal judges and juries.
• Protecting billing privileges. Coordinating the criminal defense with Medicare and Medicaid exclusion and enrollment consequences.
• Sentencing and appeal. Challenging the loss calculation, arguing for variances, and pursuing appeals and post-conviction relief.

Is DME Fraud a Felony?

Yes. DME fraud charged under the federal healthcare fraud or Anti-Kickback statutes is a felony, with healthcare fraud punishable by up to 10 years in prison per count and Anti-Kickback violations by up to 10 years per count. Beyond prison, a conviction brings fines, restitution, forfeiture, and exclusion from federal healthcare programs, which can permanently shut down a DME business. That combination of criminal and program exposure is why every DME fraud allegation should be treated as serious from the start.

How Much Does It Cost to Hire a DME Fraud Lawyer in New York City?

The cost of a DME fraud lawyer in New York City depends on whether the matter is a civil audit or a criminal case, the volume of billing records, the number of counts and co-defendants, and whether the matter resolves before or goes to trial. DME fraud cases involve extensive record review, forensic analysis, and detailed motion practice, so they require real work. Our DME fraud attorneys are transparent about fees from the first conversation and structure the representation to fit the matter. Given the prison exposure and the threat to your business and billing privileges, the more important question is usually what an inadequate defense can cost you.

A DME Fraud Attorney the National Media Turns To

When the biggest federal cases in the country are in the news, networks and newspapers call Vinoo Varghese to explain what is really happening in the courtroom. That is the same judgment and credibility our DME fraud attorneys bring to your case.

Vinoo Varghese has provided legal analysis and commentary for CBS News, Fox News, Fox Business, CNN, MSNBC, Court TV, HLN, BBC, Inside Edition, i24 News, Sky News Arabia, and Nancy Grace's Crime Stories, and has hosted true-crime legal analysis for Vanity Fair. He has been quoted as a legal authority by The New York Times, The Wall Street Journal, the New York Law Journal, Law360, the New York Daily News, and the New York Post. A former prosecutor from the Brooklyn District Attorney's Office, he is a nine-time National Trial Lawyers Top 100 honoree, an eight-time New York Metro Super Lawyer, rated AV Preeminent by Martindale-Hubbell, and has served on the visiting faculty of Harvard Law School's Trial Advocacy Workshop.

Contact a New York City DME Fraud Lawyer Now

If you or your company is under federal investigation, is facing an audit that may be turning criminal, has received a subpoena, or has been charged with DME fraud anywhere in New York City, do not wait and do not talk to anyone but your lawyer. DME fraud defense is part of our broader healthcare fraud defense practice, and a DME fraud attorney who has stood in the courtroom and tried the cases can change what happens next.

Call Varghese & Associates, P.C. for a confidential consultation. Our office is located at 2 Wall Street, Suite 310, New York, NY 10005, steps from the federal courthouses of the Southern District of New York.