What’s California’s Top Medicare Scam?




By Karen Fletcher

If you’re not already on Medicare, imagine being one of our country’s 55 million older adults or younger people with a disability on Medicare. Imagine getting a cup of tea and looking forward to relaxing in your chair, watching a favorite TV program and hoping that darn back ache would just go away! Then, during a commercial break, something catches your eye.

“Medicare covers a remarkable new device that can give seniors freedom from lower back pain,” says an ad about back braces. “If you have Medicare, this brace is FREE for you! Call in today, give us your Medicare number and we’ll send you your brace. Get ready to feel better and reclaim your youth!”

Wow! While this may sound too good to be true, if I were in pain, on a fixed income and just wanted some hope that I could make my back feel better, this ad would be very enticing. It is, and it works! This ad and many like it are scams, yet thousands, if not millions of Medicare beneficiaries are falling victim to such durable medical equipment (DME) scams each year.

Last year, one of our Senior Medicare Patrol volunteers saw such a commercial on TV. He happened to be watching a program he had pre-recorded via a digital video recorder (DVR) when the commercial popped up. Because of his work with SMP on fraud prevention, he immediately knew this was one of the scams SMP educates about and watched closely. The end of the commercial had a fine-print disclaimer that ran for just a few seconds – not enough time for anyone to read without freezing the image. Because it was on his DVR, however, our volunteer froze the screen. Here’s what it said (company name is made anonymous):

“By calling in, I confirm that this will serve as my signature authority for COMPANY and their customers to call me on my telephone at the number provided. I am aware of my rights to protect my privacy and these rights are waived for the purpose of COMPANY and their customers to call me. I consent to receive information on products not limited to spinal support braces and/or knee braces on this phone call or subsequent phone calls … I am permitting calls to be automatically dialed. … If I am on a do not call list, by opting in, I am waiving this right.”

So, this disclaimer says, in effect, that by calling that toll-free number a person is giving the company permission to sell their information to any and all of their customers, and that they and/or their customers can call the person as often as they want for any product they’re selling. A person is also agreeing to be the recipient of robocalls, just by calling to find out about the back brace.

This is scary, AND it explains a disturbing trend we’re seeing. Namely, that once a beneficiary falls prey to such a DME scam, be it via a TV commercial, or an ad in a newspaper (also often with a very fine print disclaimer), they can find themselves in a vicious loop of receiving unwanted, and at times relentless phone calls, and unwanted durable medical equipment products. One of our SMP clients recently reported receiving over 30 such calls a day. Sometimes beneficiaries are charged for some of these unnecessary products, and Medicare, undoubtedly racks up large bills under the beneficiary’s Medicare number for them.

Here’s one recent example that came to our California Senior Medicare Patrol (SMP). In this case, a service coordinator first contacted her local Health Insurance Counseling and Advocacy Program (HICAP), where she worked with Muriel Smalheiser, who is also one of our SMP volunteer liaisons. One of her residents complained to her about receiving numerous unwanted packages from DME companies (10 in total). This service coordinator had been aware of Medicare fraud and scams through some of our SMP presentations for residents, so when she heard this complaint, she immediately suspected fraud and called HICAP/SMP.

With a little investigation, SMP found that this all started when the resident called the number on a TV commercial advertising braces, similar to the commercial mentioned above. The resident received more braces than she had agreed to, and when she refused the additional braces, the DME company told her “it’s a package deal and she had take them”. These companies aren’t taking no as an answer.

In looking at this beneficiary’s Medicare Summary Notices, SMP also found that Medicare has already paid thousands of dollars worth of unnecessary braces on this beneficiary’s behalf. In total, Medicare paid nine claims from six different DME suppliers, most of whom probably got this beneficiary’s Medicare number from the original company she called regarding the TV ad. The delivery of unwanted, unnecessary braces proves how much damage can be done when a Medicare number becomes compromised and when a beneficiary falls victim to this ever-growing DME fraud.

Stopping the fraud cycle

So how do we stop this vicious cycle of fraud? It starts with you. It starts with me. It starts with us all being aware of this problem and knowing what the Medicare rules are. It also takes knowing what the common scams are and sharing this information with our loved ones, clients, colleagues and community and then being vigilant about reporting fraud.

While Medicare does cover medically necessary durable medical equipment, the key is it must be medically necessary. And a beneficiary’s physician makes that determination and must prescribe the equipment for it to be covered by Medicare. Anyone who says they just need your Medicare number and you can have a back brace, knee brace, wheel chair, etc for “FREE” is involved in a scam.

Besides the estimated $60-90 billion lost to fraud each year, Medicare beneficiaries receiving unwanted and unnecessary durable medical equipment also can have serious consequences on their access to equipment if/when they need it. For example, we’ve had cases where a beneficiary accepted the offer for a “free” no-frills $100 wheelchair while the DME company charged Medicare for a $5,000 electric wheelchair. Later, when the beneficiary actually needed an electric wheelchair, Medicare denied his claim stating he already had one. 

How you can help

Our California Senior Medicare Patrol (SMP) is on a mission to put an end to the DME scams and your help is critical. Now that you know Medicare’s coverage policy for DME (needing a doctor’s prescription for medical necessity), being aware of the common scams out there will help you be able to spot fraud, and to educate your clients about potential fraud. Even though the scams are constantly morphing, knowing some of them gives you the gist. You’ll be able to “smell” fraud if you come across it and help your clients spot it too.

Here are some of the various scams we’re seeing in California:

  • Beneficiaries disclose personal information to callers offering them braces
  • Beneficiaries respond to TV commercials advertising braces to alleviate pain and later receive a low quality brace or no brace at all
  • Medicare pays hundreds of dollars for DME that is medically unnecessary and/or DME that isn’t rendered.
  • Scammers call beneficiaries telling them that a UPS package is waiting for them, and to accept it, they must give their personal information.

We thank you in advance for spreading the word and awareness about these DME scams. Please join us in urging beneficiaries to guard their Medicare cards and remind them that if they are in need of any DME, they should consult with their doctor first to obtain medical necessity. If you or someone you know comes across DME fraud, report it to our California SMP at 1-855-613-7080. Together we can strengthen the Medicare program, protect beneficiaries and their benefits and put an end to this fraud. 

Karen Joy Fletcher, MPH has over 19 years of experience in Medicare training, education and advocacy and has served as CHA’s Publications Consultant since 2004. She is the primary researcher, writer and editor of CHA’s website content, including CHA’s newsletter and blog. She also develops and revises key educational materials, spearheads CHA’s social media and chairs the Senior Medicare Patrol Media Team and SMP superheroes skit team.

In addition to her work in Medicare advocacy, Karen teaches Earthgym and Qigong at schools, conferences, festivals and retreat centers around the country and abroad, and co-leads Qigong & Wilderness retreat trips in China. She also enjoys ample nature and family time in the Cascadian forests and mountains