Durable Medical Equipment by Steven Mussey MD

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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.

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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?

Nope!

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. 

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “Durable Medical Equipment by Steven Mussey MD

  1. Bridget Reidy MD
    September 24, 2014 at 12:20 am

    I love the part of the request where it says I need to go over the results. It gives me a chance to point out to the patient that I am not the only human being on the planet that thinks taking measurements for no purpose, like potentially changing management, is a waste of time and resources. I always start diabetic visits with “So how have your sugars been” and 99% of the time I am told the most recent reading, no matter how many strips have been used or paid for since my last visit. And it’s not as if they call me if they’ve been getting lots of lows or highs in between no matter how much I plead. Of course the powers that be that want us to do A1Cs on a schedule instead of when they might have some use in changing management don’t help.

  2. Pat
    September 21, 2014 at 6:59 pm

    Excellent post! The Direct Primary Care approach might be a blanket policy for these bastards that you do not take their calls or fill out their forms, and prescriptions for this stuff will only be given to the patient during an office visit.

  3. Russell Brunet
    September 21, 2014 at 12:07 pm

    It’s Arriva Medical and they send me crap all the time as well. I actually called them out on it. I spoke with a supervisor and asked that they stopped sending me requests. He told me that they would only stop for an individual patient, but wouldn’t stop completely. I told them that I would never approve anything except for appropriate diabetic supplies and haven’t gotten any requests for penis pumps or back braces since then.

  4. Board Certified Scrotologist
    September 21, 2014 at 9:00 am

    Our office policy is that the patient has to bring in the request themselves. We do not respond to faxes from these companies.

  5. Sir Lance-a-lot
    September 21, 2014 at 7:12 am

    Why not tell us the name of the company, Doug?

    – Eric

    • Doug Farrago
      September 21, 2014 at 8:53 am

      Steven Mussey blacked it out and I can’t remember the name off hand
      DF

      • Sir Lance-a-lot
        September 21, 2014 at 9:23 am

        That is an excellent reason.

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