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Medicare in the News - Payments to Dead Doctors & other Issues

The Washington Post reported that Medicare has paid millions of dollars for durable medical equipment (DME) prescribed by doctors who were dead at the time of billing. The government established the Medicare Fraud Task Force to try to prevent such abuses, but fraud continues to costs us billions of dollars each year. No wonder health care is so expensive. Senator Norm Coleman - R (MN) said, "...scam artists have treated Medicare like an ATM machine...".

Durable medical equipment (DME) is medically necessary, prescribed by a doctor and is not useful to a person in the absence of an illness or injury, and is appropriate for use in the home.
Look in the phone book or the internet to see all of the suppliers - there is a huge potential for quick profit and unscrupulous suppliers have no problem obtaining beneficiaries’ Medicare health insurance claim numbers. Most DME providers only need a business license and supplier number. Then they need to fill out claim forms verifying medical necessity to Medicare.

• The DME supplier is required to fill out Certificates of Medical Necessity (CMNs) describing products and equipment to be used by the patient. There is a medical information section on the form which must be completed by a physician. This is where fraudulent suppliers can forge the information of deceased physicians.
• When medical necessity has been documented by the beneficiary’s doctor, the Durable Medical Equipment Regional Carrier (DMERC) may purchase or make monthly payments to suppliers for rented DME. Once the equipment is no longer needed the supplier is not entitled to payments and beneficiaries notify the supplier to pick up unused equipment.

Unscrupulous suppliers may obtain Medicare claim numbers fraudulently as a path to pursuing Medicare dollars:
  • Beneficiaries are paid for their Medicare number or goods and services are exchanged for the number
  • The elderly are preyed on. Be wary of phone calls offering health surveys or health screenings.
    • "What is your Medicare number?" - guard and protect this number just as you do your social security number
  • Lists of Medicare beneficiaries are obtained from long term care facilities
Recruiters or “cappers” offer money to beneficiaries to visit a clinic for medical screening tests. The beneficiary receives a cursory examination and prescription for DME equipment that is not medically necessary. Medicare is billed for supplies the claimant does not receive and the claimants receive other household goods at a profit for the DME provider. Numerous cases of power wheelchair fraud have made headlines. Medicare is billed for a power wheelchair and a less expensive scooter is provided to the claimant. Medicare and Medicaid beneficiaries are actively solicited (we have all seen the TV commercials) for motorized scooters. Federal health care programs and private insurers are billed for motorized wheelchairs, which cost about twice as much as scooters that were provided.

Discharge planners used to be a nurse or social worker employed by hospitals and medical care centers to help patients transition smoothly from the hospital facility to the home or long term care facility. Today, some erstwhile "discharge planners" in medical centers are actually employees of DME suppliers. Conflict of interest, anyone? Unneeded equipment and supplies are ordered. Federal and private insurers pay the bill. I have personally witnessed this little trick: The beneficiary calls the provider to pick up rental equipment that is no longer needed. The provider doesn't pick it up for months because they can continue to bill for it until they do. Or they can send the wrong equipment and bill for the wrong and right equipment because it was contaminated just by virtue of the fact that it was delivered.

To Report Suspected Medicare or Medicaid Fraud
Call Toll-free 1-866-726-2916

It is illegal and fraudulent to:

• misuse a Medicare claim number to receive medical care, supplies, or equipment
• To bill federal programs for services not provided
  • to bill for a more expensive or Medicare covered item when a less expensive, non-covered item was provided (upcoding)
  • Submit duplicate claims for the same service
  • provide kickbacks (payments) to doctors for patient referrals
  • obtain Medicare numbers through false pretenses (telemarketing, health screenings, medical surveys, or offers of goods and services)
These are but some examples of the flagrant abuses of Medicare. Type in "medicare fraud" in our Search Box to learn more.

Thank you taurusaficionado for use of photo Scooter Lady.
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