There is an inherent adversarial relationship between the DME supplier and CMS. On the one hand, the DME supplier markets products and services, receives the physician’s order, obtains the necessary supporting documentation, delivers the product and educates the patient, and bills and collects from Medicare. On the other hand, the Medicare contractor audits the supplier’s documentation. If the contractor concludes that the documentation is deficient, then the contractor will assert that Medicare should not have paid the claim and the supplier is required to repay Medicare. Layered on top of this tension are investigations by the National Supplier Clearinghouse (NSC) and the Office of Inspector General (OIG). If the NSC/OIG concludes that a DME supplier’s claims result from a kickback arrangement, a Stark violation, a...