An Examination of Deviance and Deviants in the Durable Medical Equipment (DME) Field: Characteristics, Consequences, and Responses to Fraud

Abstract

The literature indicates Medicaid fraud is pervasive and comprises a substantial portion of health care spending. One type of Medicaid fraud that has not been explored is durable medical equipment fraud. This study seeks to fill this gap in the literature by examining the characteristics of durable medical equipment fraud cases investigated by Medicaid Fraud Control Units. Content analysis was used to review 258 reported cases of durable medical equipment fraud. The findings indicate that providers engage in a range of offenses and are subject to a variety of sanctions. Policy implications and recommendations for future research are provided.

Notes

Totals do not add to entire sample size of 258 due to missing data.

*Total does not add to total sample size of 258 due to missing data.

Some offenders were subject to more than one sanction. Thus, the percentages do not add up to 100%.

***p < .01.

¹The majority of cases reported by Medicaid Fraud Control Units occurred in Texas. This would appear to suggest that more cases of durable medical equipment fraud occur in Texas. However, this finding is the result of a large-scale investigation in Texas that ended in December 2006 with the apprehension of over 30 durable medical equipment providers.

²Nearly one-fourth of the cases had missing data on the variable measuring the dollar amount involved in the fraud incident. Bivariate analysis not reported here indicated that this variable may significantly influence whether an offender is sentenced to incarceration; however, the large number of missing cases precluded the inclusion of this variable in a multivariate model.

Additional information

Notes on contributors

Christina Policastro

CHRISTINA POLICASTRO received her M.S. from the University of Tennessee at Chattanooga in 2010. She is currently pursuing her Ph.D. in Criminal Justice and Criminology at Georgia State University. Her research interests are elder abuse, intimate partner violence, and victimization.

Brian K. Payne

BRIAN K. PAYNE is a Professor and Chair of the Department of Criminal Justice at Georgia State University. He received his Ph.D. in 1993 in Criminology from Indiana University of Pennsylvania. His research focuses on elder abuse, crime policies, family violence, and community-based sanctions. He is the author of five books including Crime and Elder Abuse: An Integrated Perspective, Crime in the Home Health Care Field, and Family Violence and Criminal Justice and he has published more than 120 scholarly journal articles. His works have been reviewed in outlets such as the New England Journal of Medicine, AgeVenture News, and The Gerontologist. He is a recipient of numerous awards including the Southern Criminal Justice Association's Outstanding Educator Award and the Indiana University of Pennsylvania's Department of Criminology Distinguished Scholar Award.