Crown Medical Solutions LLC, a Medicare supplier of knee braces, heel stabilizers and back braces, and its owners, Michelle and Philanzo King, have agreed to pay $825,000 to resolve allegations that they submitted false claims to Medicare, the Justice Department announced September 21. The government alleged that from Nov. 1, 2017, through April 30, 2019, the company billed Medicare for equipment that was not medically necessary or not properly prescribed by a physician. The settlement resolves allegations only, and there has been no determination of liability.
What the government alleged about Crown’s brace billing
Crown was a supplier of durable medical equipment, the category of Medicare-covered items that includes orthopedic braces, walkers, wheelchairs and similar products prescribed for use at home. According to the Justice Department’s announcement, the United States alleged that Crown and its owners billed Medicare for braces and related equipment provided to beneficiaries when the items were not medically necessary, were not properly prescribed by a physician, or both.
The alleged conduct ran for about 18 months, from Nov. 1, 2017, through April 30, 2019. The claims were brought under the False Claims Act, the federal law that lets the government recover money paid out on false or fraudulent claims. The department said the $825,000 figure reflects the defendants’ ability to pay, a factor prosecutors weigh when a company or individual cannot cover a larger amount.
“The Department of Justice is committed to fighting healthcare fraud and holding accountable those who exploit federal healthcare programs for personal profit,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division.
Match the brace to the paperwork. The Crown case turned on whether equipment was properly prescribed and needed, and the same questions decide coverage when a doctor orders a brace, so it helps to track orders, notices and costs in one place with The Medicare Cost & Coverage Protection Kit.
A whistleblower case from Georgia
The settlement also resolves a lawsuit brought by a whistleblower, Karen Martinelli, under the qui tam provisions of the False Claims Act. Those provisions allow a private person to file suit on behalf of the United States and to receive a portion of any recovery. The case is captioned United States ex rel. Martinelli v. Crown Medical Solutions, LLC, et al., No. 1:19-cv-01660, in the U.S. District Court for the Northern District of Georgia.
Martinelli will receive approximately $123,750 of the settlement, according to the department, or about 15 percent of the total. The docket number shows the suit was filed in 2019, the same year the alleged billing period ended, which means the case took roughly seven years to reach a resolution.
The resolution was a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Northern District of Georgia. Trial Attorney Anna Jugo and Assistant U.S. Attorney Neeli Ben-David handled the matter.
The Justice Department placed the case within a broader push against fraud in federal programs. It said the administration launched a Task Force to Eliminate Fraud and a National Fraud Enforcement Division this year, and that the Civil Division’s False Claims Act work will support both. When people exploit these programs for their own financial gain, the department said, “they defraud the government, harm the people these programs are designed to aid and protect, and undermine American businesses that play by the rules.”
Why brace billing matters to Medicare patients
Orthopedic braces are among the most familiar items in the durable medical equipment category, and they are ordered for common conditions among older adults, from knee arthritis to lower-back pain. That makes them an attractive target for improper billing, because a claim for a brace can look routine on paper even when a beneficiary never needed the device or never saw a doctor about it.
Improper equipment claims carry costs for beneficiaries beyond the dollars taken from the Medicare trust fund. Part B generally leaves beneficiaries responsible for coinsurance on covered equipment after the deductible, so an unnecessary brace can come with an out-of-pocket charge. And every improper claim draws on the same Medicare funds that pay for the care older Americans actually need, which is why the government pursues suppliers years after the billing took place.
The Justice Department did not identify any individual patients in the Crown case, and the settlement does not decide whether any particular beneficiary’s brace was covered or appropriate. It resolves the government’s claims against the company and its two owners.
How beneficiaries can check their own equipment claims
Every Medicare beneficiary receives a Medicare Summary Notice, or an Explanation of Benefits from a Medicare Advantage plan, listing the services and supplies billed in their name. Reviewing those statements is the most direct way to spot a brace, back support or other item that was never ordered, never received or never discussed with a doctor.
A few warning signs come up again and again in equipment cases: a package arriving without a prior conversation with a physician, a telephone offer of a free brace, or a request for a Medicare number from someone who is not a known provider. Beneficiaries who notice any of those can call the supplier and their doctor to ask who ordered the item.
Tips about potential fraud, waste or abuse can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477), the number the Justice Department listed with the Crown settlement. The HHS inspector general also takes reports online, and Medicare explains its own process for reporting fraud and abuse.
Beneficiaries do not need proof of fraud to ask a question. A charge that does not match a doctor’s orders is worth raising with the plan or with Medicare directly, and keeping copies of prescriptions, delivery slips and notices makes those conversations faster.
Keeping equipment orders and Medicare notices side by side
A supplier settlement closes the government’s case against one company. For a beneficiary, the open question is usually closer to home: whether each item billed under their Medicare number matches something a doctor actually ordered.
The Medicare Cost & Coverage Protection Kit includes the prior-authorization appeal steps and a medication and cost tracker, along with 51 state Medicare cost-help packs for finding local assistance with out-of-pocket costs.
Set up a running record of orders and charges with The Medicare Cost & Coverage Protection Kit.
This article was prepared with AI assistance and reviewed against the linked official sources.
David M. Keller is a finance writer based in Columbus, Ohio, covering personal finance and consumer-focused economic topics. He earned his degree in journalism from Ohio University and began his career reporting on local business and economic trends for a regional media outlet. Since then, he has contributed to a variety of online publications, focusing on clear, practical coverage of topics such as cost of living, debt, and everyday financial decision-making.
