Senior Citizens to read this Fraud Alert regarding Durable Medical Equipment

News from Aging, Posted on Thu, 03/30/2017 - 2:06pm

Anne Parks, Cattaraugus County's Medicare Health Insurance Coordinator through the Department of Aging, encourages Senior Citizens to read this Fraud Alert regarding Durable Medical Equipment.

The following text is from New York SMP's Spring/Summer 2017 Fraud Alert:

Walkers and wheelchairs and braces, oh my!

Join the fight against Durable Medical Equipment fraud

Have you ever received a postcard in the mail saying you’re eligible for a free back brace? Maybe someone has called to tell you that your doctor has approved you for a free knee brace—all you need to do is provide your Medicare number! Sounds like a good deal, right? Maybe too good?

Unfortunately, it is. Durable Medical Equipment (aka DME) scams are some of the most common forms of healthcare fraud. But what exactly is DME? And why are these offers considered scams?

First, DME is designed to mainly be used in your home. It could be a walker, a wheelchair, a hospital bed, or some kind of brace. These pieces of equipment are intended to uniquely fit you! For example, a knee or back brace will require your measurements, & a wheelchair will not only fit your body, but be specially measured to ensure you can move throughout your home. A DME supplier is required not only to thoroughly gather this information, but also to ensure a perfect fit.

Secondly, there are several reasons these phone calls and postcards are considered scams. To start, Medicare representatives are not allowed to solicit by mail or phone. And in order for Medicare to cover a piece of DME in the first place, you need a prescription from your doctor stating why you need it. Lastly, DME is covered by your Part B plan and almost always has a copayment.

So “What’s in it for the scammer?” Two things: Personal Information and Money! With these scams, the person on the phone will almost always ask for your Medicare number, which also happens to be your Social Security number. That information in the wrong hands could be really harmful. Most of the time, scam artists will then bill Medicare for a piece of equipment - sometimes more expensive than the one they may have sent you—and collect the money for themselves. Not only can they wrongfully use your Medicare benefits, but they could, and often do, commit identity theft. With your Social Security number, they are able to open bank accounts, credit cards, and request loans in your name - all without your knowledge or permission.

The Nightmare Before Christmas

This is a story about a gentleman named Roy and his run-in with a DME scam the week before Christmas.

Roy received a call from a man named Jim who said he worked for Medicare. Jim asked Roy if he had been experiencing any knee pain lately. How does he know?! Roy wondered to himself, and confirmed he had knee pain from time to time. Jim said Roy could receive a “free” knee brace because Medicare would pay for it. Jim asked Roy to confirm his Medicare number and told him he’d receive the brace soon. Jim sent Roy a knee brace and then billed Medicare. The knee brace did not fit Roy, so he never used it.

One year later, Roy injured his knee in a fall, and his doctor wrote a prescription for a knee brace. However, Medicare would not cover the cost of the brace because Medicare already paid for one for Roy (the “free” one Jim sent him last Christmas!).

Roy had to pay out-of-pocket for the knee brace he now really needed.

A sales person who calls you on the phone CANNOT:

  • Diagnose or assess your health care needs

    That is your doctor’s job. Your health care provider knows you and your medical history. Don’t let a sales person talk you into something you do not need.

  • Prescribe DME for you

    Would you take medicine from a person other than your health care provider? Of course not! The same holds true for DME. Only your doctor can order DME for you.

  • Fit you for DME over the phone

    It is impossible for someone calling on the phone to make sure equipment will fit you, and that is the job of the DME supplier. A good DME supplier will work with you until the equipment fits you just right and works properly for you.

This sounds bad. How can I protect myself?

We’re glad you asked ...

We like to tell people that knowledge is power. By knowing how scammers operate, you can stop them in their tracks. It’s important to be wary of any offers that promise “free” products or service. After all, there’s no such thing as a free lunch! So, don’t be afraid to hang up the phone or toss that postcard in the trash.

However, you don’t just have to play defense… YOU can help us fight fraud! We encourage you to be proactive and report any suspicious activity to the New York Senior Medicare Patrol. This information not only shows us if scammers are targeting a specific neighborhood, zip code, or city, but it also helps us report fraud trends to the proper authorities.

If you ever have any questions or concerns, don’t hesitate to contact the NY Senior Medicare Patrol program. We’re here to help you.

YOU can report Medicare scams and fraud by calling the New York SMP at 877-678-4697

News from Aging

Filed under: fraud