KG April 2024 Durable Medical Equipment Fraud: Tips to Protect You and Your Medicare

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:

• Be sure your doctor has assessed your condition and orders the equipment or supplies.
• Never sign a blank form from your health care provider or equipment supplier.
• Always read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). Look for charges for equipment you do not need, never requested, or did not receive.
• If you rent and return medical equipment, always get a dated receipt.
• Protect your Medicare, Medicaid and Social Security cards like credit cards.
• Do not accept products or services from strangers who call or knock on your door.
• Do not give out your Medicare number at a presentation or during a sales pitch.
• Do not accept money, gifts or unnecessary equipment and supplies from a supplier in exchange for your Medicare number.

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?

• DME that Medicare covers includes, but is not limited, to:

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

• Prefabricated orthotics that Medicare covers include, but are not limited, to:

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

• Suppliers who offer “free” equipment but bill Medicare.
• Suppliers who want you to use their doctors (not yours), who then prescribe unnecessary medical equipment.
• Suppliers or doctors who provide medical equipment or supplies you never requested.
• Suppliers or doctors who charge for items you never received.
• Suppliers who bill for people who have passed away.
• Suppliers who request your Medicare number at a

presentation, during a sales pitch, or in an unsolicited phone call.

• Beneficiaries who willingly allow their Medicare number to

be used in exchange for money, gifts, or unnecessary equipment and supplies.

• Suppliers who deliver an off-the-shelf product but bill Medicare for a more costly product.

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