As different types of scams come and go, one type remains constant: durable medical equipment, or DME, schemes. DME includes medical devices and supplies that are prescribed by a person’s doctor, can withstand repeated use, serve a medical purpose, and can be used in the home. Examples include braces, orthotics, and mobility aids such as walkers, canes, crutches, and wheelchairs.
Medicare only covers DME if you get it from a supplier enrolled in the Medicare program. Medicare Part B pays 80% of the approved amount and you pay the other 20%. “SMPs received reports of beneficiaries agreeing to be mailed one back brace but receiving packages holding multiple, unneeded braces for a variety of body parts,” said Jeffrey Woodland, SMP Hawaii Volunteer Coordinator. “Many of these braces cost almost $1,000, meaning that this type of fraud increases the cost of Medicare for everyone. Beneficiaries who give out their Medicare numbers are also at risk of having their medical identities stolen. They may receive equipment or genetic testing kits they don’t want or need and could even be left responsible for large bills for these items,” he said.
Here’s what you can do to stop DME scams:
How Can Your Senior Medicare Patrol (SMP) Help?
SMP Hawaii is ready to provide you with the information you need to PROTECT yourself from Medicare fraud, errors and abuse; DETECT suspicious activity and REPORT your concerns. Our program helps educate and empowers you in the fight against health care fraud through education, resources and referrals that you can share with your family, friends and others. Join the fraud fight by asking about our volunteer program today!
What Does Medicare Cover in Relation to DME, Orthotics, and Prosthetics?
Blood sugar monitors and test strips, canes, continuous positive airway pressure (CPAP) devices, crutches, hospital beds, infusion pumps and supplies, oxygen equipment and accessories, patient lifts, walkers, wheelchairs, and scooters
Shoulder, knee, back, wrist, and ankle braces
Prosthetic devices that Medicare covers include, but are not limited, to:
Breast prostheses (including a surgical bra), one pair of conventional eyeglasses or contact lenses provided after a cataract operation, ostomy bags and certain related supplies, some surgically implanted prosthetic devices (including cochlear implants), and urological supplies
Examples of Durable Medical Equipment Fraud Schemes
presentation, during a sales pitch, or in an unsolicited phone call.
be used in exchange for money, gifts, or unnecessary equipment and supplies.
Example Medicare Charges for DME
Any Medicare code that starts with an “L” indicates that it is an orthotic, which is a type of DME. Here are some examples:
L0625-LO651: Lumbar Orthosis – Back brace
L1810-L1860: Knee Orthosis – Knee brace
L1900-L1990: Ankle-foot Orthosis – Ankle brace
L3650-L3678: Shoulder Orthosis – Shoulder brace
L3763-L3931: Wrist Orthosis – Wrist brace