STOP SENIOR SCAMS: Durable Medical Equipment Fraud Scheme
Source: The FBI Philadelphia Field Office
Older Pennsylvanians and caregivers are important partners in combatting fraud in the health care industry. Health care fraud takes many forms, including the exploitation of Durable Medical Equipment (DME).
These items are prescribed by a doctor to treat a medical need at home. Examples of DME include wheelchairs, surgical supplies, braces, catheters, nebulizers and feeding tube supplies. While legitimate DME and orthotics companies play an important role in providing these supplies to patients, fraudulent companies take advantage of unwitting Medicare beneficiaries for their own financial gain.
A popular DME scheme involves the use of telemarketers to obtain the private information of Medicare beneficiaries. This information is then used to fraudulently bill Medicare for medically unnecessary pieces of DME.
The consultants or telemarketers are hired by the DME company and are the organizer(s) of the scheme. They facilitate the actions of those involved. The call center contacts the beneficiaries; confirms they are on Medicare and transfers them to the telemedicine company. The telemedicine company employs doctors who write medically unnecessary prescriptions for DME. The call center collects the prescriptions and sells them to the DME company. After the DME company buys the prescriptions, they send the equipment to the beneficiaries. The company bills Medicare and pays kickbacks to the co-conspirators.
Watch out for these red flags for DME fraud schemes:
- You see on your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) charges for equipment you do not need or did not receive.
- You receive medical equipment or supplies that you never requested or ordered.
- You receive an unsolicited request for your Medicare information at a presentation, during a sales pitch, in an email or phone call.
Report fraud
If you or someone you know believes they have been the victim of health care fraud, you can report suspected fraud to the FBI online at https://tips.fbi.gov or call 215-418-4000. If you suspect Medicare fraud, report it to 1-800-MEDICARE (633-4227) or at medicare.gov/fraud. Philadelphia Corporation for Aging’s Older Adult Protective Services Unit investigates reports of suspected elder abuse, including financial exploitation, 24/7 at 215-765-9040.
The FBI Philadelphia Field Office leads a Health Care Fraud Task Force that’s comprised of federal, state and local law enforcement agencies.
