One of the biggest “avenues” of Medicare fraud is with suppliers of durable medical equipment (DME). Last February the Centers for Medicare and Medicaid Services (CMS) reported that two-thirds of the roughly $10 billion Medicare spent on the program were “improper” payments. While some of this is fraud and some is just errors in documentation, this number shows that fraud accounts for a huge percentage of the money Medicare is paying out for DME.
Why DME? Until recently:
- There were no professional licensing requirements;
- Suppliers could set up shop with very little investment; and
- There was huge potential for quick profit.
By knowing of common scam tactics, you can help us detect and report fraud. Some things to look out for include DME suppliers who:
- Send unauthorized, unsolicited supplies to beneficiaries
- Send authorizations to doctors to obtain fraudulent equipment orders
- Deliver supplies to beneficiaries without a prescription or authorization
- Obtain medical records illegally
- Deliver more supplies than required (i.e. diabetes test strips)
- Deliver lower cost equipment than what is prescribed (i.e. a manual wheel chair versus a power wheel chair) and submit a claim for higher cost equipment (this will show up on a beneficiary’s Medicare Summary Notice)
- Pay beneficiaries for illegal use of their Medicare numbers
If you or someone you know detects any of the above situations, please gather any documentation materials and call our Senior Medicare Patrol (SMP) at 855-613-7080. These are honestly earned tax dollars being swindled away to fraudsters. By each of us being aware of common tactics, reviewing our Medicare Summary Notices to make sure the items and treatments charged for are indeed items and treatment received, and reporting any suspicious activity, we can significantly reduce Medicare fraud and abuse. See our section on Medicare Fraud for more info.