Did you see the ad for the free back brace in the newspaper? The one covered 100% by Medicare? Or, did you hear the TV infomercial claiming they will get you anything you need to ease your pain – “No money out of your pocket”?
If you did, it’s a scam! Medicare only covers durable medical equipment (DME) that is medically necessary with a doctor’s prescription. Scammers, however, hope you don’t know that. They just want your Medicare number to bill Medicare for equipment you never receive, or to bill Medicare for much more expensive equipment than you receive.
Here’s an example from one of our Senior Medicare Patrol’s recent cases. A beneficiary responded to a DME ad in her local newspaper about a “free” Medicare-covered back brace. All she needed to do was provide her Medicare number and name of her primary physician. When she asked what Medicare’s cost would be, they said $199.90. Yet when her “back brace” arrived, it strangely looked like a back belt she saw at Home Depot for $19.99. Also, when looking at her Medicare Summary Notice (MSN), she saw Medicare was billed $1350 and paid the supplier $1100, far more than the $19.99 look-alike belt and the $199.90 price they quoted. Worse yet, she also received a bill for $226.
In another example, a beneficiary reported receiving a “call from Medicare” offering her a free back brace. All she had to do was give her name, date of birth and physician’s name. The beneficiary then received a package from a supplier followed by multiple calls demanding payment of $1,000. This supplier is interestingly the same supplier for her diabetic supplies, and is a company that promotes orthotic braces for pain management.
While this second example is under investigation (as is the first one), it highlights a couple important warning signs in spotting fraud:
- Medicare will not call you. They do not need to know your name and DOB; they already have it.
- As stated above, Medicare only covers DME that is medically necessary AND prescribed by a doctor. The request should originate from your doctor, not a supplier.
In both examples above, the DME supplier is sending numerous faxes to each beneficiary’s physician requesting authorization for certain DME supplies. Yet neither the patients nor the physicians requested these supplies, and this supplier continues to fax the doctor authorization requests despite the doctor’s repeated demands for cessation.
These cases highlight a suspicious trend, as in both cases a beneficiary’s DME supplies provider misuses the beneficiary’s information in order to encourage more DME sales.
If you spot such trends, or any of the scams mentioned or other variations of such scams, report them to our California Senior Medicare Patrol at 1-855-613-7080. See our website and fraud alerts for more information on Medicare fraud at cahealth.susanflemingdesign.com.