Health Beat: Watch Out, This Medicare Scam Begins With A Phone Call
A sophisticated solicitation can convince a patient to ask for unneeded equipment, and trick a doctor’s office into going along with it.
Watch your back! And in particular, companies looking to profit off your backaches.
Recently I received a fax from a company with the motto, “nothing to lose but the pain.鈥 On the front was a picture of Joe Namath, a former pro football quarterback who is .
The fax said a patient of mine had contacted the company and was requesting 鈥渁n insurance approved product in order to reduce pain and/or assist with their medical condition.鈥
All it required was my signature. The next page was a pre-filled prescription, and the requested medical equipment of a back brace, shoulder brace and knee brace.
It seemed odd, since this patient has a history of arthritis, but no pain, and generally gets along fairly well. She has refused pain medication or any surgery for her condition.
But these things come across my desk every once in awhile. Diabetic shoe requests for a patient who doesn鈥檛 have diabetes but was watching a commercial about qualifying for free shoes late at night. Scooters for patients who feel it will help them get around and are lured by the commercial that assures insurance coverage.
I figured I would wait until the patient came to the office to ask her about it.
That鈥檚 when things got interesting. She said someone had been calling her repeatedly asking if she has joint pain. She refused to answer a few times, but the calls kept coming, often at odd hours. The caller finally mentioned that if she answered a few questions, then that was all they needed. Before she knew it, the phone was transferred to someone else, and she was on the line with the representatives from the company that faxed me.
Technically, the fax was right that she had contacted the company, but through an intermediary who had persistently called her. And she had answered a few questions. She had been told she needed knee replacements but since she didn鈥檛 have pain, she didn鈥檛 think much about it. Sure, she had shoulder pain, that was chronic, and also back pain. If there was a brace that could take her pain away, of course she would want to live pain-free.
That explained the fax.
The form was already filled out with the types of braces she supposedly wanted, and suggested diagnoses for her insurance coverage, along with a request for clinic notes documenting the medical necessity of the braces that no one had requested.
This 10-minute phone call would have generated $3,966.92 in revenue for the use of braces that my patient openly admitted she didn鈥檛 need and had no intention of using.
I asked her if she had intended to wear all these braces, trying to picture her with a back brace, a shoulder brace and two knee braces. How would she even put these on herself? Would she be able to move with all of these devices? If she wasn鈥檛 having pain, why would she be wearing all of this?
As for how much all this would have cost, that聽took a bit of digging. The Centers for Medicare and Medicaid Services posts a list of coverage amounts for different codes
The back brace: $1,255.76.
The knee braces: $849.98 each
The shoulder brace: $1,011.20
This 10-minute phone call would have generated $3,966.92 in revenue for the use of braces that my patient openly admitted she didn鈥檛 need and had no intention of using.
The amount of information that the company gathered was alarming. Her address, birthdate, Medicare number, my name, National Provider Identifier number, office fax, address.
The idea seems foolproof. Fax paperwork to busy doctor鈥檚 offices. I鈥檓 certain that it鈥檚 often signed without a further glance. Once the braces are sent, Medicare is billed, and there is no way to return the products. If the proper authorization is not obtained, then the patient might be responsible to pay the full amount.
Given the numbers of seniors who are on Medicare plans, the potential dollar amount is staggering. From 2010 to 2016 Medicare spent
We all pay for this, because Medicare is funded by taxpayer dollars. That鈥檚 why it鈥檚 imperative to be wary of these types of scams. Sharing this information with your loved ones can help.
There are certainly people who need back, shoulder and/or knee braces. But responding to a telephone solicitation is not the best way to obtain medical equipment.
If my patient had actually needed a brace, the next step would have been to have her see an orthopedic specialist who would know exactly which type of brace she needed before finding a company that could fulfill her needs.
She decided she was fine without braces. And the next time someone calls soliciting her information, she鈥檚 going to hang up, and try to find a way to get off of the telemarketer’s list.
I am suggesting to all of my patients that they do the same.
Thoughts on this or any other story? Write a Letter to the Editor. Send to news@civilbeat.org and put Letter in the subject line. 200 words max. You need to use your name and city and include a contact phone for verification purposes. And you can still comment on stories on .
