Every day in the office, a scam artist is trying to commit Medicare Fraud. In Primary Care, you might be missing it and become an unsuspecting accomplice.
The issue is Durable Medical Equipment and some of the biggest companies daily try to con you into signing off on items you did not order. There are many variations on the fraud, but it amazes me how openly these companies try to commit crime… or more accurately, how they try to get YOU to commit crime.
Medicare enforcement and our own professional practice organizations greet these efforts with a great big yawn.
Examples we see daily from one company in our office:
Patients on Medicare are urged by their carrier to use a certain company to provide their diabetic supplies. That company immediately acquires the doctor information and patient information. Since the supplies are for diabetes, they can safely assume the patients have obesity, painful joints and a failing sex life.
Immediately, the company rolls into action.
The company salesperson contacts the patient by phone.
The salesperson asks the patient about frequency of glucose testing and encourages increased frequency of testing. You may have written “test once a day” on your original script, but the fax comes to your office asking approval and justification for two or three times a day. If you correct the request, it comes back to you as being improperly filled out. This happens repeatedly on the same patient until you or one of your partners relent and approve the increased request and complete the section for the increased use justification.
In the same conversation with the patient, the salesperson asks: “Do you ever have any back pain? Do you have knee pain? Do you have trouble with sex?”
The answers will always be “YES” to the above questions for the obese diabetic patient over age 65.
So, a few days after you get conned into approving the increased expensive diabetic supplies, you get another request from the same company, saying the patient has ordered a back brace. If you write “DENIED” on the request, it comes back the next day, anyway. IF you keep writing “DENIED,” your phone rings and a nagging voice asks why you are not responding to their important durable medical equipment request.
If you finally give in and approve the order, more requests come for knee braces and other devices.
Who knew providing diabetic supplies could be such a lucrative business?
But are they doing anything illegal?
The fraud is your fault.
All they are asking is your order. They have even been helpful and communicated with the patient so they can respond compassionately. They would never be so unscrupulous as to provide supplies without a physician order. They certainly cannot be held responsible for your failure to verify medical necessity or appropriateness.
See? The doctor is always the problem.
Meanwhile, spineless organizations like the American Medical Association and the American College of Physicians could care less. Perhaps this is for the best.
Otherwise, these organizations might mandate more “physician education,” rather than shutting down the actual scam artists who work their art in open daylight.
By the way, I verified these typical conversations both with the patients and with the telephone salespeople. In fact, I was astonished at how honest and openly one particular salesperson discussed the tactics involved.
Editor Note (Farrago) – OMG! I have been getting this crap for the past year. I even know of a doctor who used to just approve them because he was so overwhelmed. I immediately trash the requests but they keep coming. It’s the same company as the one above too! Once, I remember, finally giving in because the patient was complaining (have to get good grades on those satisfactions surveys, you know). I regretted it ever since. Everyone, please share this blog entry on the internet so doctors can STOP writing for this unproven junk. We are all paying for this.