Tips for protecting yourself and your Medicare 

This is a time of year when thoughts turn to giving… just be careful you’re not getting taken. Especially if you’re an older health consumer. Care magazine® will be spotlighting several medical scams that even savvy seniors can fall for.

Scammers are offering Medicare beneficiaries tests and “free” durable medical equipment to obtain their Medicare information for fraudulent billing purposes, or possibility medical identity theft. In a medical equipment scam, someone reaches out to you with an offer of a “free” (as in, “Medicare will pay for it”) brace, wheelchair, or another device. You might get an unsolicited phone call, see an advertisement, or be approached at a health fair or similar event.

Durable medical equipment (DME) and orthotics 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. DME and/or orthotics are considered medical equipment prescribed by your doctor that can withstand repeated use, serve a medical purpose, and can be used in the home. However, many fraudulent companies across the country are charging Medicare beneficiaries for this equipment without showing the medical necessity and sometimes without even sending the equipment to the beneficiaries. 

Medicare Part B covers medically necessary durable medical equipment, or “DME,” that is prescribed by your doctor, can withstand repeated use, serves a medical purpose, and can be used in the home. 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%. 

What does Medicare cover in relation to DME, Orthotics, and Prosthetics? 

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

Examples of Durable Medical Equipment Fraud Schemes 

What can you do to stop DME fraud? 

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 

Always read your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). Call Medicare (800-633-4227) or your insurance company if you see claims for supplies or services you don’t recognize.  

Report your concerns about billing errors or possible fraud to Medicare and your local SMP (Senior Medical Patrol). In South Carolina, the Department on Aging/SMP can be reached at aging.sc.gov or call 1-800-868-9095.

You may also contact the fraud hotline at the U.S. Department of Health and Human Services’ Office of Inspector General (OIG). You can also contact the OIG by phone (800-447-8477) or email (spoof@oig.hhs.gov).

Sources: https://www.smpresource.org/Content/Medicare-Fraud/Fraud-Schemes/

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