Warnings continue on Medicare scams

Officials continue to warn Medicare recipients that they should not take cold calls offering to send them durable medical equipment like back or leg braces, and Montana Senior Medicare Patrol is calling on people to help in the fight.

“Medical supplies are continuing to be big business for fraudsters,” a release from Senior Medicare Patrol said. “Though Medicare has ways of helping combat this fraud, the first line of defense is you, the person receiving the Medicare Summary Notice.”

The U.S. Department of Health and Human Services Office of Inspector General said in a consumer alert that in one scam, the scammers are offering Medicare beneficiaries orthotic braces that are supposedly free to them and covered by Medicare. Fraudsters may call beneficiaries directly to offer braces or use television or radio advertisements to encourage beneficiaries to order free braces by calling the phone number provided.

If a beneficiary provides or verifies personal or Medicare information, a brace is sent even if it is not requested by the beneficiary or medically necessary. Often, a beneficiary receives multiple braces. Medicare is then billed for each brace using the beneficiary’s information.

Event though the victim is not billed for that brace directly — all who pay into Medicare are paying for it — it can have consequences to the victim, the alert said.

“If a beneficiary has received unwanted or unneeded braces, and that equipment is billed to Medicare, then Medicare may deny a brace that the beneficiary needs in the future,” it said.

And people don’t even have to confirm that they are Medicare recipients or give out any information. An April news report from New Jersey printed in SMP New Jersey Advocate, the Asbury Park Press, the Daily Record (Morris County), and the Bergen Record (Bergen County), said a woman did not answer a dozen phone calls over three days, knowing they were robocalls, then decided to pick up to see what it was. She hung up on a recorded message telling her Medicare would pay for a new back brace. A few days later she received a box full of medical braces.

She later found out Medicare and her secondary insurance paid $2,601 to the company.

Investigators are making progress. A release in April said a Health and Human Services Office of the Inspector General led to charging 24 defendants in 17 federal districts on allegations the fraudsters submitted more than $1.7 billion in Medicare claims and were paid more than $900 million. In the alleged scheme, medical professionals working with fraudulent telemedicine companies received illegal kickbacks and bribes from medical equipment companies in exchange for prescriptions for medically unnecessary orthotic braces. The medical equipment companies then used the prescriptions to fraudulently bill Medicare.

Hill County’s Area X Council on Aging reports that calls are still coming in in this region, with people asking what they should do when they receive calls or durable medical equipment they didn’t request.

Senior Medicare Patrol has reminded people that businesses cannot offer unsolicited durable medical equipment — DME — like braces, wheelchairs, catheters and so on.

“The Social Security Act prohibits suppliers of durable medical equipment from making unsolicited telephone calls to people on Medicare … People on Medicare should be aware that DME sent by a supplier needs to be prescribed by their doctor,” a Senior Medicare Patrol release said.

The HHS Office of Inspector General offered some tips on how people can protect themselves:

• People should be suspicious of anyone who offers them free medical equipment and then requests their Medicare number. If a person’s personal information is compromised, it may be used in other fraud schemes.

• A physician that that the person knows and trusts should approve any requests for equipment to address their medical needs.

• Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than their physician’s office requests your Medicare information, they should not provide it.

• People who suspect Medicare fraud can contact the HHS OIG Hotline online at https://oig.hhs.gov/fraud/report-fraud/index.asp or at 1-800-HHS-TIPS (1-800-447-8477); TTY 1-800-377-4950, or by mail at U.S. Department of Health and Human Services, Office of Inspector General, ATTN: OIG HOTLINE OPERATIONS, P.O. Box 23489, Washington, DC 20026.

Montana Senior Medicare Patrol also lists some steps for people who are contacted by DME scammers:

• People should report receiving any braces not ordered as fraud to 1-800-MEDICARE (1-800-633-4227)as soon as possible.

• People should contact the supplier about returning the braces. They should not have to pay for the return.

• If people return the item, they should make sure they have a mail receipt and tracking number.

• People should check their Medicare Summary Notice to see the name of the ordering provider and be sure to tell 1-800-MEDICARE if they have never visited that person.

• Three to four weeks after people report the fraud to Medicare, they should receive an adjusted Medicare Summary Notice showing that Medicare has approved a zero dollar amount for the claim. It means that Medicare has recouped or will recoup payment.

• People should report the possible fraud to Senior Medicare Patrol of Montana by calling the closest office in Montana at 1-800-551-3191. They will need copies of the caller’s MSN’s and will fill out a form to gather the necessary information in sending the case on.