Some HME/DME suppliers sell unnecessary equipment to seniors, increasing scrutiny for all
With the tight margins of the DME industry, many providers are searching for ways to bring in extra revenue, but are some of these strategies ethical and within the law? There are many reported cases in which seniors are being targeted and pressured to buy medical equipment that they don’t want or need. Oftentimes, the pressure comes in the form of multiple phone calls nearly every day and robotic voicemail drops offering medical devices and equipment at no cost to them, all by Medicare-approved suppliers.
According to CMS, soliciting seniors for unnecessary or unwanted medical devices is not a new trick, and “the practice contributes to the estimated $60 billion in fraudulent Medicare payments each year.” (1) While CMS requires that medical device suppliers “get written permission from Medicare beneficiaries before contacting them unless the person has already received an item from that supplier in the previous 15 months,” this rule is frequently violated. (2)
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In one case, an 84-year-old woman was contacted with an offer of a knee brace. Although she declined the brace, the DME supplier faxed an order for both the knee brace and a home electrotherapy machine to the woman’s doctor for his approval. The supplier claimed that the patient requested the items, which would have been paid for by Medicare. And no matter how many times the patient told callers that she didn’t want the knee brace, the supplier continued to call and continued to send orders to the doctor for approval. According to the news report, “in the past three months alone, her doctor’s office received eight separate orders for knee braces and electrotherapy machines that she supposedly asked for.” (3)
In another case, when a 73-year-old male visited a doctor for an elbow issue, he was then fitted for a knee brace by a non-physician who was in the office, with the promise that it wouldn’t cost the patient anything. Later, the elderly man received a statement that indicated that Medicare had paid $992.44 for the brace, which the patient was never able to use. The patient reported that he “was never billed for the $215.18 he normally would have owed under Medicare Part B. However, he also pointed out that taxpayers are in fact paying: “… It does cost us. We all pay into Medicare.” (4) After this fiasco, the man began receiving calls for other equipment—reportedly “at least 35 calls from suppliers offering him braces, hearing aids, or other devices.”
Another tactic is “free” medical alert systems for seniors, offered via robocalls, which actually include a monthly monitoring fee. The Federal Trade Commission has become involved to crack down on these “blatantly illegal and deceptive” telemarketing programs, but as soon as one is shut down, it seems another pops up to replace it. (5)
Obviously, these types of practices reflect poorly on all suppliers, including those who would never resort to dishonest or deceptive strategies. These types of practices also place every HME and DME business at additional risk because Medicare, trying to uncover fraud, will only increase its audits. In addition, other programs, such as Senior Medicare Patrol, are stepping up their efforts to identify and report fraud. So make sure your documentation is in order, and keep your business on the right side of the law.