Home medical devices a draw for scam artists

By Mary Beth Franklin
Maturity News Service

If you are among the millions of elderly or disabled Americans who require special medical equipment in your home for health reasons, Medicare may cover most of the cost.

But be careful. There are numerous scams involving home medical equipment suppliers that cost the government billions each year in Medicare fraud and might leave you stuck with equipment you don't want or bills you didn't expect.

Generally, Medicare helps pay for equipment that is medically necessary, appropriate for use in your home, and prescribed by a doctor. Oxygen equipment, wheelchairs, chairs equipped with special lift devices, and hospital beds are examples of devices that may be covered.

But some types of equipment are not considered medically necessary and therefore are not covered because they are equally useful to people who are not sick or injured.

Your personal doctor is usually the one to decide what medical equipment you need in your home. Either the doctor or a hospital discharge planner can refer you to one or more suppliers who can meet your medical equipment needs.

If the supplier "takes assignment," which means accepting the Medicare-approved amount as payment in full, Medicare will pay 80 percent of the approved cost of the equipment and you pay the remaining 20 percent. The reimbursement rules apply to both rentals and purchases.

If a supplier does not take assignment, Medicare will still pay the same 80 percent of the approved cost and you will be responsible for the difference between what Medicare pays and what the supplier charges.

To save money, always try to find a supplier that accepts medicare assignment.

If you have a private medigap policy that covers medical equipment in your home, your insurance will cover the 20 percent of the cost that Medicare does not pay.

While there are plenty of reputable and reliable medical equipment suppliers, there are also those in the business of defrauding the Medicare system, whether by charging for equipment that's never delivered or by selling devises that aren't medially necessary.

"The plethora of scams out there makes the whole program vulnerable," said Judy Berek, a senior adviser at the Health Care Financing Administration, the agency that administers Medicare. "We are all paying for it," she added. "If we let scam artists destroy our program, we wont have a program or we'll have to give up other things."

Altogether, the General Accounting Office estimates that Medicare fraud cost the government $18 billion last year - about 10 percent of the cost of the entire program.

Unscrupulous suppliers trying to bilk the Medicare system often offer Medicare beneficiaries free medical equipment whether they need it or not.

"If someone offers you free medical equipment, be leery," warns Michele Kimball, a legislative associate with the American Association of Retired Persons who specializes in health care fraud. "Only your doctor can prescribe medically necessary equipment."

Similarly, if a medical equipment supplier offers to waive the 20 percent Medicare co-payment, don't bite. It's illegal and should be reported to your Medicare carrier whose name and telephone number is listed on your Medicare statements.

Watch out for telephone solicitors or door-to-door salesmen who tell you that you are entitled to certain medical equipment under the Medicare program at no cost to you.

No medical equipment is free. You may find yourself with equipment that Medicare wont pay for and a supplier who wont let you return the item. You could get stuck with a bill you didn't expect.

Also beware of suppliers who try to convince you that you need a more elaborate device than your doctor prescribed.

For example, if your doctor says you need a manual wheelchair and your supplier persuades you to accept a souped-up electric one, Medicare will cover only 80 percent of the cost of the prescribed version. You will be responsible for the difference.

One final warning, "Never, ever, under any circumstances give your Medicare number out to someone you don't know," advises Kimball.

She suggests that Medicare recipients safeguard their identification number just as they would a credit card number. Otherwise, a scam artist can use that number to commit costly fraud that can ultimately undermine the Medicare program.

The Department of Health and Human Services has established a national tip line for reporting Medicare and Medicaid fraud. The number is (800) HHS-TIPS, or (800) 447-8477. You can call Monday through Friday, 9 a.m. to 8 p.m. EST. You do not have to give your name.

You can also write to the Office of Inspector General, U.S. Department of Health and Human Services, HHS-TIPS, Hot Line, P.O. Box 23489, Washington, D.C. 20026.