DME Rules 

Under Section 1834(a)(17) of the Social Security Act, companies that sell medical equipment can't call Medicare beneficiaries without permission, unless:

1. The beneficiary agrees in writing to be contacted by phone.

2. The call is about a medical item they've already received.

3. The supplier has provided them with medical equipment in the last fifteen months.

Breaking these rules and submitting a bill for payment can lead to legal consequences, including being excluded from federal health care programs.

Rules and Guidelines that suppliers of durable medical equipment (DME) should follow when contacting Medicare beneficiaries:

• Respect Privacy: Suppliers should respect the privacy of Medicare beneficiaries and should not share their personal or medical information with others without their consent.

• Provide Information: When making contact with beneficiaries, suppliers should provide clear and accurate information about the DME they offer, including its benefits, costs, and any other relevant details. They should not provide misleading or false information.

• Written Consent: Suppliers should obtain written permission from beneficiaries before making any unsolicited telephone calls or sending any marketing materials. This written consent should clearly state the purpose of the contact and the beneficiary's agreement to be contacted.

• Record Keeping: Suppliers should maintain records of all communications with beneficiaries, including details of the written consent, the nature of the calls, and any agreements or transactions.

• No Pressure or Coercion: Suppliers should not use high-pressure tactics or coercion to persuade beneficiaries to purchase DME. Beneficiaries should be given ample time to make informed decisions.

• Avoid Kickbacks: Suppliers should avoid offering kickbacks or incentives to beneficiaries in exchange for their business. Such practices are illegal and can result in severe penalties.

• Billing Transparency: Suppliers should provide clear and transparent billing practices, ensuring that beneficiaries understand the costs associated with the DME and the billing process.

• Compliance with Medicare Rules: Suppliers should adhere to all Medicare rules and regulations related to the provision of DME. This includes ensuring that the DME meets Medicare's coverage criteria.

• Reporting Violations: Beneficiaries are encouraged to report any violations or suspicious activities by suppliers to the appropriate authorities or Medicare.

These additional rules emphasize the importance of ethical and lawful practices when dealing with Medicare beneficiaries and aim to protect their rights and privacy while ensuring the integrity of the Medicare system.

There are several other laws and regulations that suppliers of durable medical equipment (DME) should be aware of when dealing with Medicare beneficiaries. These laws are in place to ensure the proper provision of healthcare equipment and services while preventing fraud and abuse. Some important laws and regulations include:

• Anti-Kickback Statute: The federal Anti-Kickback Statute makes it illegal for suppliers to offer or receive any form of remuneration, including kickbacks or bribes, in exchange for referrals or business related to Medicare or other federal healthcare programs.

• Stark Law: The Stark Law prohibits physicians from referring Medicare patients for certain designated health services, including DME, to entities with which they have a financial relationship, unless specific exceptions are met.

• False Claims Act: This law imposes penalties on individuals or entities that knowingly submit false or fraudulent claims for payment to Medicare. It includes provisions for whistleblowers to report fraud and receive a portion of any recovered funds.

• Health Insurance Portability and Accountability Act (HIPAA): HIPAA mandates strict privacy and security standards for protected health information (PHI). Suppliers must ensure the confidentiality and security of Medicare beneficiaries' health information.

• Medicare Fraud and Abuse Laws: Medicare has specific fraud and abuse laws that prohibit fraudulent billing practices, including upcoding (billing for a more expensive item or service than provided) and unbundling (billing separately for services that should be billed together).

• Supplier Standards: Medicare sets specific standards and requirements for suppliers of DME, including accreditation and quality standards. Suppliers must comply with these standards to participate in the Medicare program.

• Medicare Benefit Policy Manual: Suppliers should consult the Medicare Benefit Policy Manual for detailed guidance on coverage criteria and documentation requirements for various DME items.

• State Laws: Suppliers should also be aware of state-specific laws and regulations related to the provision of DME, as these may vary from state to state.

" To find information on DME laws and regulations in a particular state, you can typically start by contacting the state's Department of Health or relevant regulatory agency. They should be able to provide you with the most up-to-date information and guidance on compliance. Additionally, you can also consult legal resources specific to your state or seek guidance from industry associations that may have state-specific information."