Protect Yourself From Durable Medical Equipment Fraud

by: Education and Outreach, from: AARP, Updated April 23, 2012

What You Can Do

— Darren Greenwood/Aurora

Always review your Medicare Summary Notice (MSN) or insurance Explanation of Benefits (EOB) for mistakes. If you see any charges for durable medical equipment that you do not need or did not receive, report it as suspected fraud.

Similarly, if you receive an unsolicited call to buy medical equipment your doctor has not ordered, speak up.

Report questionable charges or sales pitches to: Medicare.gov, 800-633-4227 (800-MEDICARE), TTY: 877-486-2049.

If you have private insurance, report suspected fraud to your insurance company's anti-fraud department. You should find a number to report fraud on your insurance Explanation of Benefits. You may also want to contact your state insurance department.

Durable medical equipment fraud is one of the leading ways criminals commit health care fraud. They do so by filing false insurance claims with Medicare or your insurance company.

Durable medical equipment, such as wheelchairs, scooters, walkers and oxygen supplies, are prescribed for you by your doctor. Nebulizers, incontinence supplies, orthotics, prosthetics and hospital beds for use at home are also considered durable medical equipment.

Examples of durable medical equipment scams include:

• Shipping medical equipment to patients before their doctor provides a prescription or the required Certificate of Medical Necessity.

• Billing for duplicate orders.

• Deliberately shipping more than the amount ordered or what is reasonably necessary.

• Billing for more expensive items than those that are shipped.

• Failing to give credit for an item that is returned.

• Forging documents that can only be signed by a doctor.

• Stealing insurance identification numbers to use for false claims.

• Paying patients and physicians to submit fraudulent claims.

• Billing all residents in a nursing home, as if everyone in the home needed and received the equipment.

Ways you can protect yourself from durable medical equipment fraud:

• It's illegal for a medical supplier to make unsolicited telephone calls to people with Medicare. The exceptions are if you have given written consent to have the supplier call you, the call is about an item the supplier already provided to you, or the supplier has delivered equipment to you in the previous 15 months. Also, a supplier may call you to confirm delivery and billing information for a new item if you know that your doctor is contacting the supplier on your behalf.

• Suppliers cannot get around the phone call ban by hiring an independent marketing firm. Medicare will not pay claims from suppliers who make unsolicited, illegal telephone calls to Medicare beneficiaries.

What you can do:

• Always review your Medicare Summary Notice (MSN) or insurance Explanation of Benefits (EOB) for mistakes. If you see any charges for durable medical equipment that you do not need or did not receive, report it as suspected fraud. You can get help understanding what’s in your MSN at our MSN decoders.

• Similarly, if you receive an unsolicited call to buy medical equipment your doctor has not ordered, speak up.

• Report questionable charges or sales pitches to: Medicare.gov, 800-633-4227 (800-MEDICARE), TTY: 877-486-2049.

• If you have private insurance, report suspected fraud to your insurance company's anti-fraud department. You should find a number to report fraud on your insurance Explanation of Benefits. You may also want to contact your state insurance department.