FRAUD RESOURCE CENTER
Medicare spends more than $6 billion a year on durable medical equipment (DME) — wheelchairs, walkers, braces and other devices prescribed by doctors to help patients deal with an injury or chronic illness at home. That’s a boon to beneficiaries but also a big draw for fraudsters, who exploit older Americans’ health care concerns to enrich themselves.
In a medical equipment scam, someone reaches out to you with an offer of a “free” (as in, “Medicare will pay for it”) brace, wheelchair or other device. You might get an unsolicited phone call, see an advertisement or be approached at a health fair or similar event. Sometimes, it’s a garden-variety government impostor scam: Someone claiming to be from Medicare calls to say you’re eligible for a free knee or back brace, and they need your Medicare or Social Security number to process the benefit. You may or may not get a brace, but the crooks get what they need to steal your identity.
Those cons victimize individual consumers. The big business in DME fraud involves unscrupulous equipment suppliers ripping off Medicare on a grand scale. Using telemarketing and hard-sell tactics, unscrupulous equipment suppliers lure you into ordering their wares, get your health care information, obtain bogus prescriptions (by paying kickbacks and bribes to doctors or by forging their signatures) and file false claims. They stick Medicare with the bill for costly devices that are not medically necessary, not properly prescribed or not delivered to patients at all. (DME fraud might also target Medicaid or private insurance companies.)
And a big business it is. In April 2019, federal authorities charged 24 people with operating a complex scheme to market back, knee, wrist and shoulder braces to hundreds of thousands of elderly and disabled Medicare recipients. This scam alone cost the government more than $1.2 billion. These and other losses related to DME fraud are borne by the taxpayers who fund Medicare and by beneficiaries shouldering higher premiums and out-of-pocket costs.
Don’t let your health concerns make you an unwitting accomplice to fraud. Take these steps to avoid medical equipment scams.
- You receive an unsolicited call or other communication offering a free or low-cost medical device as a Medicare “benefit.”
- Someone claiming to be from Medicare asks for your Medicare or Social Security number. Medicare representatives almost never make unsolicited calls to consumers and do not ask for personal information by phone.
- Your quarterly Medicare Summary Notice (MSN) or an explanation of benefits (EOB) from your health plan lists medical equipment you did not order or receive.
- Do hang up on unsolicited calls offering you a medical device that will be billed to Medicare.
- Do carefully review MSNs and EOBs. Call Medicare (800-633-4227) or your insurance company if you see claims for supplies or services you don’t recognize.
- Do be aware that if you accept an offer of medical equipment, you could be responsible for up to 20 percent of the Medicare-approved cost of the item.
- Don’t give your Medicare or insurance number to strangers. Share it only with trusted health care providers.
- Don’t order durable medical equipment over the phone unless advised to do so by your physician.
- Don’t accept delivery of medical equipment unless it was ordered by your doctor.
- Don’t be swayed by scare tactics, such as claims by an equipment provider that you should get a device now because Medicare is running out of money. Charging Medicare for equipment for future use, before your doctor certifies it as medically necessary, is illegal.
- If you suspect a medical equipment scam, report it to Medicare at 800-633-4227 and to the fraud hotline at the U.S. Department of Health and Human Services’ Office of Inspector General (OIG). You can also contact the OIG by phone (800-447-8477) or email (email@example.com).
- Federally funded, volunteer-run Senior Medicare Patrols (SMPs) can help you identify equipment fraud and other deceptive health care practices and notify the appropriate authorities. Contact your local SMP for information.
Published: May 31, 2019
More From the Fraud Resource Center