Stuff You Don’t Need: Medical Equipment Fraud

The graphic above links to an article by David A. Fahrenthold, published in The Washington Post a few months ago about a particular Medicare scam involving power wheelchairs that has gone on for years. Scammers made millions of dollars by employing the following strategies. First, they were able to get lists of stolen Medicare ID numbers or pay someone to round up patient names. Then, they were able to buy copies of doctors’ signatures or use the signatures of deceased doctors. They filed false claims for these chairs, because the profit margin was potentially huge. And they counted on the fact that Medicare cannot check every single one of the over four million claims it gets every day. The Justice Department has begun to prosecute these particular scammers, but there is always some other type of equipment or medical supply that scammers can use to file fake claims and make beaucoup bucks.

Recently, I became aware of yet another one of these apparent scams. I got a message from the doctor of one of my patients, asking me to provide a limb measurement for a splint so that the doctor could fill it in on the form she got, sign it, and send it off to complete the order. Thankfully, my employer has trained me well as far as patient documentation goes, and I’ve had a great deal of experience over the years filling out forms to justify the need for patients to obtain medical equipment. In this case, I knew, for example, that there was no diagnosis in the patient’s chart that related to this splint. You can’t buy supplies or equipment without a diagnosis that pertains, so I started by asking my patient about it. Neither my patient nor my patient’s family knew anything about any new diagnosis that would warrant a splint. But her family reported that my patient had lately received a number of phone calls offering ‘free’ medical equipment. After catching one of these callers in the act, they had concluded they had been made by telemarketing companies. Just to be thorough, I then assessed the limb in question, with ambiguous results.

Next, I called the doctor. Turns out that the order had not originated with her at all. She had received this order form at her office, which stated that the patient had requested the item to relieve a set of symptoms in this particular limb. The form bore the name of a generic, but plausible-sounding medical supply company and looked legitimate. I told her that the patient and the family knew nothing about this, and described the patient’s inconclusive symptoms. Finally, the doctor and I concluded that this was an attempt at fraud. The doctor also told me that their practice had received similar fraudulent orders before. She planned to report the company to Medicare.

The world is full of asshats, people, and they seem to have an endless supply of imagination when it comes to scamming our neighbors, our elderly parents, our disabled family members, or even ourselves, especially if we have experienced any significant health issues. Or even if we haven’t. Sometimes, all it takes is our phone number, and the illegally purloined knowledge of what insurance company we do business with, to be the potential victim of a fraud. A web search for fraud involving medical equipment and supplies yielded pages of results. Among them were these:

To fight back, here are a few links about how to recognize this crap and how to report it:

It’s also a good idea to make sure your phone numbers are current and listed with the National Do Not Call Registry. For more information about how the Registry works, and how to file a complaint, visit the Federal Trade Commission site.

Finally, you might want to talk to your doctors. And question everything. With a little less diligence, both I and the doctor I talked to this morning could have been hoodwinked into ordering something our patient didn’t need. The item in question is relatively small, commonly used, and doesn’t cost that much in the scheme of things. But if enough false claims were filed for this item by scammers, the profits could be considerable. And the doctor and I would have been unwittingly involved. It sure pays to be skeptical.


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“A Piece of Crap” — How I Met Tom & Ray Magliozzi

Ray & Tom Magliozzi

The Good News Garage

About thirty-two years ago, I decided I needed to find a reliable auto mechanic. I was still in my twenties, but I had finally gotten tired of relying on my dad and his local mechanics out in the ‘burbs to service my car. I was by then a card-carrying citizen of the city of Boston, in a neighborhood called Jamaica Plain. I worked across the Charles River in Cambridge, at MIT. Much of the time, I took the subway to work. Across the street from my apartment, I’d hop on the T at Forest Hills Station on the Orange Line, take it to Downtown Crossing, switch to the Red Line, ride to Kendall Square, and walk to 77 Massachusetts Avenue. There I would enter the huge, iconic main building of the MIT campus, and stroll down the infinite corridor to my first-floor office in the Department of Materials Science and Engineering, where I was a secretary to a small group of faculty members.

New England weather being what it is, however, I found myself driving to work more often. And when I drove, I listened to the radio, often tuning to WBUR, a radio station housed at the campus of my previous employer, Boston University, and one of the two NPR stations in the city. On Saturdays, WBUR broadcast this local, call-in radio show called Car Talk, moderated by a pair of MIT grads who were brothers and who happened to run a garage near their alma mater. Inevitably, my poor, tired old Toyota Corolla needed another oil change, and maybe a prayer or two, so I decided to take it to the Good News Garage and see if these dudes were as helpful in person as they were on the radio.

My first visit was straight-forward enough. I was greeted by Tom, who looked much as he did in the photo above, sort of an aging hippie type dressed in oil-stained work clothes. I knew from the show that he was a wise-ass. But though he took down my info with a certain wry efficiency, he was mostly all business that morning, and told me to come back after work, and to ask for Ray if he wasn’t there.

This was back in the early eighties, when my musical tastes ran to the Pretenders, the Clash, the Ramones, Elvis Costello, and some former, local RISD art students known as the Talking Heads. My hair was asymmetrical, clipped close to my head on one side, with a longish sweep on the other. I was known to wear a small, red, enameled safety pin in one ear. I was not known to wear tasteful business suits to work with sensible pumps. My MIT office was across the hall from a materials science facility identified as the “Creep Testing Laboratory,” the source of much sniggering humor among myself and the several graduate students who wandered into my office, looking for a professor.

While my car spent the day at the garage, I passed what was no doubt a typical eight hours, generally consisting of typing up arcane research reports or grant applications. Our department didn’t run to the new, dedicated word-processors that had recently come on the market, so I had to type on an IBM Correcting Selectric typewriter. Which was okay, except that I had to keep switching out the element ball to a Greek character one, so I could fill in the correct symbols for the calculus equations that were often liberally sprinkled throughout these documents. One of the professors wasn’t too careful about proofing his equations. Since I’d had a year of getting A’s in calculus in my thus-far unfinished college career, I used to correct them, thinking that I should get some kind of bonus for having such a skill, which was certainly not in my job description. Eventually, I wandered back to the Good News Garage to pick up my car. Tom wasn’t around, so I was greeted by Ray.

“Well,” he said, “we changed the oil. But you might want to think about getting a new car in the not-too-distant future.”

“Why? What’s wrong with it?” I asked.

Ray seemed to have to ponder this question carefully before answering. “Let me put it this way,” he finally said. “Your car is a piece of crap.”

It was only a car, after all, but still, my feelings were a little hurt. I swallowed, took a deep breath, and said, “Well, can you fix it?”

“We can probably keep it running for a while. But you are rapidly approaching that point where spending any significant cash on this thing will just be throwing good money after bad.”

“Shit,” I said. “I can’t afford a new car.”

“Where do you work?” he asked.

“At MIT.”

“Figures. Where do you live?”

“In Jamaica Plain.”

“Oh, good!” he said. “My advice is, take the T and start saving up.”

I drove home that day in a state of mild despair and not a little irritation at Ray’s bluntness. Still, I did let the Car Guys keep my car going for a while, but was ultimately forced to take their advice and junk the thing for a newer model. I also finally finished my bachelor’s degree, got a new job, and had to find a new mechanic closer to that job. I called the show a few years later, looking forward to reminding Ray of how he insulted my old car, and to reminding Tom that I spelled ‘Kathi’ with a ‘K’ and an ‘I.’ I got accepted into the call queue, but I didn’t end up getting on the air.

After that, I used to run into them occasionally. By then, their show had been picked up by NPR, which increased their celebrity status. They often served as MC’s for some of the local concerts and events I attended, like the fundraiser for the non-profit Passim’s Coffee House, held at the Somerville Theatre. The program featured several musicians who had played at Passim’s, including the then not-yet-famous Shawn Colvin, who played a poignant, acoustic version of a Talking Heads song that eventually made it onto one of her later albums. The song was called “This Must Be the Place,” but most of us just referred to it as “Home.”

Which brings me to a fitting way to end this remembrance. Tom and Ray may have come to be loved and enjoyed internationally once Car Talk made it onto the NPR program list, even earning a Peabody Award in 1992. But to us natives of metropolitan Boston or of Cambridge (“Our fair city,” as Ray & Tom called it), the Magliozzi Brothers have been always and ever our local boys. As MIT alums, their fame earned them an invitation to deliver the 1999 MIT commencement address. But long before that, they brought their sterling credentials and intelligence to a blue-collar profession that has come more and more to need the likes of MIT grads to do it properly. They came from an essentially urban, ethnic background, like so many of us, whose parents wanted us all to make something of ourselves. Their particular brand of smart-ass but affectionate humor is as familiar to us as Fenway Park, because our families had it, too. Consequently, listening to Tom’s laughter and errant silliness over the years has always been like coming home. Tommy, I know I speak for a lot of your original, long-time fans and friends when I say that we’ll miss you like a brother.
~
~
~
Tom Magliozzi died on Monday, November 3, 2014 at the age of 77 of complications related to Alzheimer’s disease.


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Pinktober Update: Komen Embarrasses Self in Hotel Lounge

Recently, Komen demonstrated the lengths to which it will go to sign up new corporate partners. Miffed at the reaction to its recent partnership with oil-drilling and fracking corporation, Baker Hughes, the iconic Komen logo was seen last Sunday night in a Pittsburgh hotel lounge, showing some leg to a prospective new partner. Earlier that day, a rally, led by Breast Cancer Action, was held outside of a Pittsburgh Steelers game, where Komen accepted a $100,000 check from Baker Hughes during half-time. Prior to the rally, protesters had gathered over 150,000 signatures to demand that Komen break its ties with Baker Hughes. The fracking process involves dozens of chemicals known to be linked with cancer.

Komen, defiant in the face of this public shaming, brought further shame on itself by deciding to tie one on in an unnamed hotel lounge later that evening. A hotel bartender, who asked not to be named, observed Komen ‘flaunting itself with some corporate type until the wee hours,’ but could not say what the ultimate outcome of this encounter was. ‘Let’s just say that I saw a room key passed across the table,’ the bartender reported. One rally participant, who was staying at the same hotel, remarked, ‘I’m certainly not surprised. We’ve all suspected for years now that Komen will do anything for money. And damn the consequences.’

~


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How to Exploit Breast Cancer, One Blogger at a Time

Flying Monkeys

I got an email last evening from a woman who said she was from one of the more venerable online news sources, one that used to be in print. She said she was a senior editor who was “working on a piece about what you shouldn’t say to a breast cancer patient, and I was hoping you could lend your insight. If you’re open to it, could you send me your thoughts on what people shouldn’t say (and why), and some examples of what they could say that would be much better? Any anecdotes or advice would be terrific, and I would love to include your thoughts.” It immediately occurred to me that one of the things you shouldn’t say to a breast cancer patient was that you’d like her to tell you what you shouldn’t say to a breast cancer patient. I emailed her back, thanked her for asking me, but suggested to her that “this topic has been done to death. If you Google ‘what not to say to breast cancer patients,’ you’ll see what I mean.” I provided a link to a post by another blogger, who has metastatic breast cancer, who’s written what I think is pretty much the last word on the subject: Stupid things people say to those with cancer & their families.

I then went on to say, “With respect, I think there are a lot more apt and important angles on breast cancer that you could write about, especially for a media outlet as esteemed as _____. For instance, how many of the 1300 breast cancer charitable organizations are actually involved in some kind of fraudulent fundraising practices?” I then referred her to my last blog post. The use of the word ‘esteemed’ might have been laying it on a little thick, but I was trying to be polite while thinking she was alarmingly unimaginative for a ‘senior editor.’ I closed with a bit of nicey-nice and sent it off.

A short time later, she emailed back, saying, “I can assure you that the team has a very robust lineup of content planned — not just this piece.” I thought her tone was a little snippy, but I suppose mine was, too. She did close with “Thanks.”

Naturally, I went to check out this news site. It’s a clean site overall, fairly well laid out, as these things go, not overly crowded with crap, as are some I could name, and it didn’t take a hundred years to load, as do others I could mention. And I found her name on the masthead, although not listed as a ‘senior editor.’ But I didn’t find a single report anywhere about breast cancer, or even about Komen’s latest nonsense with pink drill bits. And worst of all, I couldn’t find a search box either, so I couldn’t check the archives for the past few weeks since the month-of-pink-overload began. What kind of self-respecting media site doesn’t have a search box? Whatever ‘robust’ content they have planned, they better hurry up with it before the damn month is over.

Lions and tigers and bears! Oh, my!

I was never one of the really popular kids at school. But I always had a loyal band of misfit friends who stuck together. What we had going for us is that we were always nice to other misfits, and we knew how to laugh, and we mostly recognized bullshit when we smelled it.

Not so different from how my life as a blogger is now, really. Of course, I’m very grateful that people bother to read and enjoy my blog at all. Wouldn’t be half as much fun to write if they didn’t. But when you’ve been bullied from a young age by the ‘popular’ kids, and you’ve survived with your psyche more or less intact, you tend to grow up to be the sort of adult who doesn’t give a big, fat rodent’s derriere whether you’re popular or not. And you still tend to smell bullshit a mile away, or, at the very least, employ a certain healthy skepticism. I’ve come to view these qualities as advantageous in the social media world, as helping me preserve a little objectivity when I’m exploring certain subjects on this blog. I like to think I can trust myself not to get exploited by someone for their own self-serving purposes. But maybe I’m just paranoid. My mother had a personality disorder that caused her to see conspiracies everywhere, so you never know. Perhaps I’m not so much skeptical as delusional. I’ve been accused of worse.

But I can tell you, without delusion, that in the past month, I’ve received every manner of request to get me to lend my name, blog space, time, ideas, and tacit or explicit endorsement to all sorts of exploits. And these are just the few that have escaped my vigorous spam filter. Some of them are fairly harmless. Some are legit. But a lot of them amount to sales pitches, delivered under the guise of ‘supporting breast cancer awareness.’ I know for a certainty that I’m not the only one who’s received these requests. I know that many, if not most, of these people making these requests just do some kind of Google search for ‘breast cancer blogs’ and go to town. Hence, they do not make me feel special. Or popular.

I’ve received several requests to review as-yet-unpublished book manuscripts. These are generally sent by other members of the cancer club who have written a memoir or a novelized memoir. These requests are a little heart-breaking. All of these authors mention how they wouldn’t have gotten through their ordeals without the laughter and support of their friends, bolstered by cake, retail therapy, or trips to the local day-spa, which, it must be said, was basically my strategy. One would presume they asked their friends to read their stories first. But after that, why not then find one of the several professional editors out there who make a living reviewing manuscripts? Why ask me? Sure, I used to be a professional editor, almost thirty years ago, but there are only fourteen people in the world who know that.

Likewise, I’ve also gotten a few requests to review and endorse songs, written to encourage us during Pinktober. I can always use a little encouragement, musical and otherwise. But generally, I turn to music that has nothing to do with cancer when I’m feeling disgruntled. Somehow I doubt these folks sending me iTune links know that I tried to be a rock star in my youth, or that I’ve written and recorded a number of songs that parody the experience of enduring cancer treatment and the barrage of pinkwashing that’s gone with it. Frankly, I’d rather watch a Weird Al video than listen to yet another person telling me what a hero I am. Bleck.

Then there are the requests to exchange links and/or to post something about some splendid product that is sure to make my life as a cancer patient much more tolerable. These include cookbooks, Japanese dietary supplements, and special services for breast cancer patients like retreats to find one’s ‘inner warrior.’ One of the more entertaining of these was for a wrist band (pink, naturally) infused with peppermint to be worn over a certain pressure point on the wrist, which is supposed to help control nausea. One may order these wristbands at a discount by visiting their website and entering the code ‘SAVBOOBS.’

Pay no attention to the man behind the curtain.

Among the more insidious offers are invitations to visit sites that are presented as supportive, informational online venues designed to help patients figure out if they are being adequately tested after initial diagnosis. They have names like KnowYOURBreastCancer.com and MyBreastCancerTreatment.org. Far be it from me, a staunch advocate of informed consent, to eschew gathering as much information as possible when one has been told one’s biopsy is positive. The two sites mentioned describe the benefits of molecular diagnostic testing, specifically the Oncotype DX test, which can be used to help determine whether chemotherapy would be beneficial, and to calculate a recurrence risk for those with early-stage breast cancers, including the risk for invasive recurrence with DCIS. Not a thing wrong with that.

There are a few things about these sites that I do take issue with, however. One is the fine print. Unless you look for it, you’d easily miss the fact that each of these sites is maintained by companies who manufacture such tests, Agendia in the former case, Genomic Health in the latter. They are not the only companies who make molecular diagnostic tests for breast cancer, but these two want you to ask your doctor to request their tests. To my mind, this occupies the same continuum of advertising as those ubiquitous drug commercials on TV that encourage you to tell your doctor to prescribe a specific medication for heartburn, say, or arthritis. To that end, additionally, both Agendia and Genomic Health have Facebook communities. Agendia’s is called Symphony Sisterhood for Breast Cancer, the ‘Symphony’ being a panel of four tests that analyze breast tumors. Genomic’s Facebook community is called Until Every Woman Knows. Both Facebook pages invite individual women to share their stories. I received an email invitation last week from a PR firm to allow myself to be featured on one of these Facebook pages as a way “to honor people who are using social media to raise awareness about breast cancer.” Several dogged minutes’ worth of investigation brought me to the corporation behind the invite. But I didn’t find it on their Facebook page. In the ‘About’ section of both of these community pages, the corporate names behind them are not mentioned.

Somewhere over the rainbow.

Regular readers of this blog know what a snarky bitch I am. Appropriately enough, the last time I used The Wizard of Oz metaphorically was in another post about the risks of exploitation by social media. But, however much I may let the fur fly here, I do try not to be unnecessarily rude to individuals. I politely declined the invite from the PR firm, saying that I did not normally allow any corporation to use my name or blog, because occasionally, I write reviews of research about such things as molecular diagnostics, and I would prefer to maintain my distance and objectivity. The response to this was an offer of links and videos describing the research their client had done about their products. There was some back-and-forth on this, but overall, it was a cordial exchange, devoid of snippiness.

We’re all grownups here in the blogosphere, and each of us has to decide for herself how to manage her social media presence. Me? I’m still the kid who was bullied as a child, who’s grown up to be a perennial skeptic. I like to think I’m occasionally performing a kind of public service, but maybe I really am just paranoid and deluded.

“…If I only had a brain
I’d unravel any riddle
For any individ’le
In trouble or in pain…”


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