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Medicare Update: Medical Equipment Fraud

Medicare Part B covers durable medical equipment (DME), which is equipment that serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home. There have been many recent reported instances of DME fraud, errors, and abuse, so it is important to recognize what DME fraud might look like.

Some examples of DME fraud might include:

  • Someone uses a fraudulent physician’s identity, or a physician’s stolen identity, to medically certify that you need DME.
  • Someone steals your Medicare number and uses it to bill Medicare for a service that you do not need and/or was never delivered.
  • Someone offers you a meal or food in exchange for your Medicare number.
  • Someone calls you or visits your home to offer you “free” equipment that you do not need and then bills Medicare for the equipment.
  • A DME supplier bills Medicare for more expensive DME than the equipment provided.
  • A DME supplier continues to bill Medicare for rental payments for your DME after it has been returned.

To protect yourself from DME fraud, errors and abuse, learn the coverage rules about Medicare’s coverage of DME. Medicare will not cover DME unless your doctor has certified that you need it. There must also be documentation in your medical record supporting your medical need for the equipment or supplies. If you do need DME, ask your doctor about whether you meet the coverage requirements to get it. If you do, get your DME from a supplier that accepts Medicare assignment or, if you have a Medicare Advantage Plan, from an in-network supplier.

Be aware of aggressive marketing that tries to persuade you to change DME suppliers. Before making a decision to change suppliers, speak with your doctor and your current supplier to see if there is a need for you to change.

Do not respond to ads that offer “free” equipment to Medicare beneficiaries, be skeptical of offers that seem too good to be true, and do not give any personal information to someone who calls offering DME that you did not ask for.

Protect your Medicare number. Only give your Medicare number to your doctor and other providers. Be careful when others ask for your Medicare number or offer free services as long as you provide your Medicare number.

Check your Medicare Summary Notices (MSNs) if you have Original Medicare, or your Explanations of Benefits (EOBs) if you have a Medicare Advantage Plan, and billing statements regularly. Carefully look for any suspicious charges or errors. Also, remember that providers are not permitted to routinely waive cost-sharing or offer gifts or financial incentives for you to receive services from them. If you see any suspicious charges or have any reason to believe your provider is inappropriately billing Medicare for DME, call your provider to see if they have made a billing error.

If you suspect a health care provider of DME fraud, contact your Senior Medicare Patrol (SMP) by calling 877-808-2468 or visiting www.smpresource.org. Your SMP can help
identify Medicare fraud, errors, and abuse, and report them to the correct authorities.

Taken from the Medicare Rights newsletter, May 2019.