Need a Back Brace?
Did you ever see those ads or commercials asking if you had Medicare and that you can get any back brace for free? I had always thought it was a scam. Well, I was right. I am not sure if they were the same people arrested but I hope so.
Medicare scam that peddled unneeded orthopedic braces to hundreds of thousands of seniors. Two dozen people were charged, including doctors accused of writing bogus prescriptions.
The Justice Department said the scheme relied on overseas call centers to pry Medicare numbers from beneficiaries. Authorities also announced charges against owners of call centers, telemedicine firms and medical equipment companies that shipped unneeded back, shoulder, wrist and knee braces.
Profits from the scheme were laundered through offshore shell companies and then used to buy high-end cars, yachts and luxury homes here and abroad, officials said.
Medicare’s anti-fraud unit said it’s taking action against 130 medical equipment companies implicated. The companies billed the program a total of $1.7 billion, but not all of it was paid out.
The loss to Medicare was estimated at more than $1.2 billion.
I wonder if we could make our healthcare system better if we had that $1.2 billion back to play with?
I give credit for the this administration in capturing more and more healthcare criminals. Remember, this blog has been going daily for 18 years and I write about these type of stories all the time. I love them. But it was so rare until the past couple of years. Now it is all the time. I have to give credit where credit is due.
But how did this not get caught in the first place? When is the last time a private insurance company (Aetna, Anthem, Cigna, etc) get bilked for $1.2 billion.
Answer: never.
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This is the super low hanging fruit of Medicare waste. I often wonder if there are ANY practicing physicians employed in even an advisory capacity by CMS. When you look DME boondoggles like this combined with programs like MACRA and MIPS, one would have to conclude that the answer to that question is “no”.
I used to get requests for these weekly for patients and would call the patient and they didn’t know anything about it. Glad I checked because surely had I signed one they would haul me in for fraud. The new trend here is that every retirement community and assisted living center now has “in house” social work,physical therapy, OT, that they request on every resident every time they sneeze. Beware!
Over the past several years, I probably averaged one fax weekly asking me to sign the paperwork so that my patients could obtain their knee brace, back brace, compounded cream or ointment, or ED med that they “requested”. When I did follow up, most of my senior generation patients really did not understand that these were cold calls and not from their insurer or me.
I never signed one.
This is one of my many stories I could tell, after having worked for a major health insurance company as a RN. These are true story’s: -I had a request for bilateral braces for KO, WHO,AFO, shoulder, hip and a cervical collar.
-Person needing power scooter because every time she goes to WalMart there are none available.
-Group 3 power wheelchair for ALS members, being convinced to get as it is a benefit, but has 24 hr care and able and willing caregiver, with a transfer chair being the best option.
-Oh the stories I could tell!
Maybe they will stop calling my cell phone all the time telling me how they can get me a free brace. They always re-assuring me it is not a sales call as they aren’t selling me anything, but getting me a free brace if I want it. If you play along with them, as soon as you mention that you don’t have insurance, they hang up on you.
Much like Aaron, I never complete the paperwork and usually send it back with a note that it is not medically indicated.
Didn’t solve the problem yet. While reading this,I got a call trying to get a back brace for my back pain.
Sadly, the underlying cause of this is our cultural shiFt towards beggary. People are taught to manipulate big entities such as insurance companies, Medicare, what-have-you, to obtain a “payoff,” meaning getting something that other people don’t get. A scooter is a payoff; a handicapped parking placard is a payoff; antibiotics are a payoff, a back brace is a payoff. Each gives the contestant a sense of obtaining a “win” over the system.
Societies which endorse and encourage mature values, such as thrift and independence, look upon such groups as ours with distaste. Often our goal is described as “Ka-ching, baby!” and the doctor is just one of the doormats to step on so as to get a payoff.
Antibiotics are the “payoff” for the sniffles, and people go to the doctor to his the jackpot. All of our feeble attempts to persuade people of the uselessness of antibiotics in viral syndromes, are just a weak push against the tide. Common wisdom says that all doctors are, are obstacles to getting the good stuff. That belief is the absolute core of the opiate epidemic; but when the truth came out, the blame got dumped on the only folks trying to stem the tide.
The greatest punishment for society is to give them what they want, and I expect that remote prescribing, and continued breadth of scope of practice to prescribing EMT’s etc. will be here within a few years. But it is the people looking for the payoff, who drive the system forward. There still is no free lunch.
I did an article about this for this blog five years ago!
https://authenticmedicine.com/durable-medical-equipment-steven-mussey-md/
As a nurse with a major health insurance company, it was expected that these would be approved because the physician signed. No where on any past claim or H&P were these diagnosies written.
So much fraud and abuse. My employer said it wasn’t worth the time and effort to look into and attempt to stop.
One of my patients bought the brace. I was sent forms to fill out. when I refused, the person called and demanded I complete it or they would bill the patient.
As I prepared for retirement, I got emails to work for these companies. They wanted a PECOS certificate. I never responded.
Sound like the Powered scooter fiasco.