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:
- The recent arrest made by the U.S. Justice Department of the owner of a durable medical equipment company which filed 24 million dollars in fraudulent Medicare claims for items including wound care supplies.
- The August, 2014 article mentioned above published in The Washington Post.
- This list of Healthcare Fraud Investigations for 2014 posted by the IRS.
- An article by Dr. Yul Ejnes of the American College of Physicians that was published by KevinMD about scams involving knee braces, diabetic supplies and other items.
To fight back, here are a few links about how to recognize this crap and how to report it:
- StopMedicareFraud.gov. Self-explanatory.
- The Hotline for The Office of the Inspector General, U.S. Department of Health and Human Services.
- The Centers for Medicare and Medicaid Services, to report Medicaid fraud.
- And the fraud reporting section for Blue Cross Blue Shield.
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.