The Medicare Back Brace Scam

No doubt, most of you have seen the ads on television promising “free” back braces for Medicare recipients. The commercial shows a number of delighted people engaged in activities while wearing a variety of braces, happily touting the new life they now have after responding to this offer. Unfortunately, this is yet another swindle being perpetrated upon the elderly, the disabled and those living in chronic pain.

What is being promised by these companies is classified as Durable Medical Equipment (DME) by Medicare. This equipment is designed to be used in the home for those with a diagnosed disability. This equipment ranges from walkers, wheelchairs, hospital beds to, in this case, a multitude of braces.

Just why are these companies pushing braces?

Because Medicare will pay for them and the companies involved can mark up the prices on these devices and make a considerable profit. Braces are not the first health related cash cow manufacturers tried to milk. Just a little over a decade ago, a similar scheme was undertaken with motorized wheelchairs and scooters until the whistle was blown on this operation, but more on that later.

The average consumer may see these ads and say, “What’s wrong with getting help for someone from a company with medical equipment at no cost?” How could we blame someone for wanting to alleviate their pain…unfortunately, the scammers know this, too, and lie in wait to take advantage of their suffering. And as we know, there is a cost for everything.

The reality is that many of these companies and the products they hawk are designed to take advantage of the Medicare payment system while pushing recipients to seek braces that may not be medically indicated or so poorly designed that they make the problem even worse. And in some of these cases, the DME sales people may be breaking the law.

Watch this report from KLKN-TV8 News about a senior receiving a post card stating that she "qualified" for a free brace. Telemarketers are using the mail and television to promise seniors and those with disabilities "free" medical equipment.

With the television ads, with consumers initiating the call, this is not a violation of the law, but when these companies send postcards or solicit business using telemarketers who identify themselves as insurance case managers or medical providers, they have crossed the line -- according to the government.

Under the law, Medicare providers are not permitted to solicit by mail or by phone -- that's violation number one. And number two, many will misrepresent themselves to the consumer, as in the case of an unsolicited call received by a retired grandmother named Maria.

She is a retired seamstress from southern New England who has been treated for years for arthritis in her shoulders, neck, back and fingers. She received a call one day from someone stating that they had "been provided with her information" from a "medical provider" suggesting that she be screened for a free brace. For Maria, it sounded legitimate and she assumed that her doctor had made a referral.

It was a cold fishing call from a telemarketer. If Maria would have said she had no idea about this, the caller would have apologized and hung up. But in this case, they caught their fish.

Maria went along with the caller and provided all the information they requested, including her Medicare number and medical information. She was told she would soon receive a back brace paid for by her insurance. A few weeks later, she received a copy of a Medicare printout showing that her account had been billed for over one thousand dollars, but she never received the “free” brace she was promised. Attempts to resolve this problem -- to date -- have been futile and she continues to live with the pain and the anger of being scammed by telemarketers.

Believe it or not, Maria was actually lucky as it appears they only thing she was taken for was the cost of the brace. As we wrote in an earlier blog, Medicare issued new cards this year with identification numbers that replaced the recipient’s social security number that appeared on the old ones. When some telemarketers obtained the social security numbers, not only did the consumer not get the brace, but their bank accounts were emptied, and multiple credit cards were opened in their names.

If you or a loved one is contacted on the phone, know that there are several things these telemarketers cannot do when trying to sell you a “free brace”.

These include:

  1. Taking personal medical information about your symptoms and make a diagnosis. That is your primary care provider’s (PCP) job, not some unseen entity on the phone who doesn’t know your health history or may not even have any medical training.

  2. Prescribing a DME for you. Once again, this is your PCP’s job. However, there are reports that somehow, these marketers are able to get a doctor to sign off on an order.

  3. Fitting you over the phone. You absolutely, positively cannot be fitted properly for a DME without being seen by a licensed therapist trained to fit these products for your unique anatomy.

For those who do receive the braces, they are often ill fitting, of poor quality and provide no relief at all to the consumer as they were not fitted properly, forcing the user to toss them into the closet never to be used again. But this leads to a costly problem which we will discuss soon.

We also spotted a number of disclaimers at the bottom of these television commercials giving the telemarketers the right to harass you day and night should they choose to do so - with your permission just because you made the call. Below is an example of one of those disclaimers;

“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.”

This should be enough to send you running in the other direction, however to read this, you would need to be a speed reader with a magnifying glass as it appears for only a few seconds and in print that a person with 20/20 vision could not read unless they were six inches from the television screen. We were only able to read it by pausing the commercial.

We alluded to a “costly” problem with getting these often-unwearable devices, and we will relate the case of a man named Michael.

Michael struggled with knee pain for years as the result of osteoarthritis.

He is a retired construction worker from New Bedford, Massachusetts and knew he needed a knee replacement but wanted to enjoy a cruise with his wife before surgery. He received a call one day from a salesperson who stated he worked for Medicare and asked about his joint pain. Although this was an unsolicited call, Michael assumed that his doctor had sent this information to them and he provided the telemarketer his medical history.

The salesperson told Michael that he was eligible for a “free” knee brace under Medicare rules. Michael gave the caller all his insurance information and a knee brace was sent shortly thereafter and billed to Medicare. Michael took this brace with him on the vacation, but it was so uncomfortable and cheaply made that it actually caused him more problems and the pain increased. He stopped wearing the device.

Several months later, Michael suffered a heart attack and underwent bypass surgery. At the same time, the knee that needed replacement had gotten worse but because of the heart issues, his doctor did not want to do the replacement until his heart was stable, so he was prescribed a knee brace from a reputable provider in the area.

Michael was measured for the brace and upon placing the order, he was told that he had already received a brace and Medicare would not cover the cost of another one. He was stuck paying for the fitted brace because he had been scammed earlier.

Unfortunately, DME fraud and abuse cases cost Medicare millions of dollars that could be used to provide needed services to their recipients. And braces are not the only items used to scam the public.

Earlier, we briefly mentioned electric wheelchairs and scooters. It’s been over five years now since the same type of advertising for electric wheelchairs was seen on television day and night(remember the “Scooter Store” and the “Hoveround”). This scam was used to exploit another chink in the armor of Medicare, which usually paid claims without reviewing them. Using the same tactics as the brace scammers, they would make cold calls to people offering free electric wheelchairs usually at huge mark-ups to the Medicare system.

Remember this commercial from years past? Turns out that the Hoveround company and their marketers ran afoul of Medicare and were raided at their Texas headquarters resulting in a major settlement with the federal government.

On television, people could be seen singing about their scooters and even one man on the edge of the Grand Canyon with a friend yodeling in excitement over his Medicare provided scooter.

The commercials, which promised freedom and independence to people with limited mobility, had driven the nearly $1 billion U.S. market for power wheelchairs and scooters at the time. But the spots by the industry's two leading companies, The SCOOTER Store and Hoveround drew scrutiny from doctors and lawmakers, who said they created the false impression that scooters are a convenient means of transportation rather than a medical necessity.

The scooter controversy ended with a government raid on The SCOOTER Store's New Braunfels, Texas, headquarters and underscored the influence TV ads have on medical decisions.

The SCOOTER Store and Hoveround were both privately held companies that together made up about 70 percent of the U.S. market for scooters and spent more than $180 million on TV, radio and print advertising in 2011 alone.

Government auditors estimated that The SCOOTER Store received between $47 million and $88 million in improper payments for scooters and were eventually taken to court, reaching a settlement with the government. In 2013, the company closed its doors.

But it's not just scooters or braces. Other medical scams still going strong include offers of:

  • Free diabetic supplies, including glucose meters and testing strips.

  • Incontinence supplies such as adult diapers and rubber sheets.

  • Ostomy supplies.

  • Catheters

  • "Free" home health care.

And with some chatter that Medicare may be providing additional services to its recipients, you can bet that new ones will emerge in short order.

So, what can be done to avoid being a victim of the these scams?

  • Never sign blank insurance claim forms.

  • Never give blanket authorization to a medical provider to bill for services rendered.

  • Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.

  • Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have questions.

  • Do not do business with door-to-door or telephone salespeople who tell you that services of medical equipment are free.

  • Give your insurance/Medicare identification only to those who have provided you with medical services.

  • Keep accurate records of all health care appointments.

If you think you have been a victim of a fraud, Medicare advises that:

  • You may have gotten a bill or report of charges that looks wrong to you. According to Medicare, if you know the provider, call their office to talk about it. It could be an innocent billing error.

  • If you’ve contacted the provider and you suspect that Medicare is being charged for a service or supply you didn’t get, or you don’t know the provider on the claim, call 1-800-MEDICARE.

Finally, if you think you or a loved one may have been the victim of financial exploitation, give us a call. We can discuss how we may be able to help you and explore available options.

You can reach us today at 1-855-724-9400.

Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.

#MedicareBraceScam #ConnellyLAwOffices #LtdBewareofDMEfraud

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