The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

From the Office of Inspector General (OIG), U.S. Department of Health & Human Services

Durable Medical Equipment Fraud

Durable medical equipment (DME) companies offer a valuable service by providing wheelchairs, surgical supplies, catheters and respiratory nebulizers as well as nutrition and tube feeding supplies and other health care equipment. However, many fraudulent DME companies have appeared all across the country.

How the Scam Works

  • A fraudulent DME company approaches a fraudulent physician, or uses an unsuspecting physician’s stolen identity, to medically certify that a beneficiary needs supplies.
  • This same fraudulent DME company may also have stolen, or otherwise purchased, Medicare beneficiary numbers and begin to fraudulently bill Medicare for goods.
  • Typically no actual equipment is delivered to the beneficiary. He may not know equipment is being billed in his name but not delivered. 
  • In other schemes, a fraudulent DME company may offer the Medicare beneficiary meals or food in exchange for her Medicare number. The DME company may also provide the beneficiary with nutritional supplements. (Be aware that Medicare only pays for nutritional support when the beneficiary has a feeding tube in place.)
  • Other common costly DME items that are offered include “custom” diabetic shoes, oxygen, nebulizers and therapeutic mattresses. 
  • Sometimes the beneficiary is aware of the fraud and is paid a “kickback” in cash for selling his Medicare information. 

How to Fight Back

  • Do not let anyone except your physician’s office handle your Medicare card. If anyone other than your physician's office requests you to provide your Medicare information, do not provide it.
  • Never accept “free” medical equipment or services in exchange for your Medicare number. Nothing is ever free.
  • Review your Explanation of Benefits paperwork for items that appear that you did not order or receive and report any discrepancies immediately.

Report Suspected Fraud

To report suspected fraud, click here.

 

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