This past winter, John Ernest got a call that showed up on his caller ID as being from “Medicare,” asking if his father, Dean, who lived in a nursing home at the time, needed a free orthotic brace for pain. John knew that Medicare would not be calling him and that the call was fishy, so he said “no” and hung up. He didn’t give out his father’s Medicare number, nor did he consent to anything.
A few days passed. Not just one but 10 braces worth about $4,000 addressed to Dean arrived at the younger Ernest’s house. He received a back brace, two knee braces, two arm braces, two suspension sleeves, an ankle brace, a wrist brace and a heel stabilizer — none of which Dean Ernest wanted or needed.
The braces came from four different medical equipment companies and were prescribed by four health care professionals. John was surprised to say the least. A prescription is typically required to receive an orthotic brace, but he is sure he didn’t talk to any doctors during the phone call.
Since then, John enlisted help and reported his case to the Medicare. Yet, he still receives calls often with individuals on the line who say they work for Medicare and ask for Dean Ernest’s information ― though his father died in April.
Telehealth Fraud is Happening More Frequently These Days
Telehealth fraud appears to be on the rise, ironically at the same time as more patients are opting into virtual appointments with their physicians via audio and video technology.
This past April, the Centers for Medicare & Medicaid Services (CMS) finalized policies that increased plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits, and many are taking advantage of these benefits. For aging adults with mobility and transportation challenges, telehealth offers a welcome respite from in-person office visits. Frequent doctor’s appointments become less of a strain for seniors and their caregivers, who often must take time off work to accompany their loved one. The early intervention afforded by telehealth also helps prevent unnecessary emergency room visits and hospital readmissions. While this is good news for patients themselves, telehealth was also designed to ease the burden on America’s health care system by improving efficiency and reducing costs.
Sadly, while prescriptions for durable medical equipment, such as orthotic braces or wheelchairs, have long been a staple of Medicare fraud schemes, some alleged scammers are now using telehealth and unscrupulous health providers to prescribe unneeded equipment to distant patients. Taxpayers are the ones who ultimately pay for this and other types of Medicare fraud, as it often leads to higher health care premiums and higher out-of-pocket costs.
How Telehealth Scams Work
Ariel Rabinovic, an expert on senior fraud, describes how these scams work. Typically, the fraudsters enlist unscrupulous health professionals, including doctors, physician assistants, and nurse practitioners, to contact people they’ve never met by telephone or video chat under the guise of a telemedicine consultation. Sometimes the crooked health professionals will come on the line and ask questions such as, “Do you have any pain?” explained Rabinovic. But oftentimes, there is no contact between the doctor and the patient before they get the equipment in the mail, as was the case with John Ernest in our example. And in almost all of the cases, the person prescribing the braces is somebody the Medicare beneficiaries don’t know. Often these doctors don’t perform medical consultations, but rather write prescriptions without talking to patients, as in Ernest’s case. Of course, this is NOT how telemedicine is designed to work.
“Operation Brace Yourself” Halted a 1.2 Billion Dollar Scam, Yet Scams Still Continue
In April 2019, the Department of Justice (DOJ) announced that investigators had busted what they called “one of the largest Medicare fraud schemes in U.S. history.” “Operation Brace Yourself” cracked an international scam that defrauded Medicare of more than $1.2 billion by using telemedicine doctors to prescribe unnecessary back, shoulder, wrist, and knee braces to beneficiaries.
The DOJ charged 24 people, including three medical professionals and the corporate executives of five telehealth companies. According to federal court documents, Willie McNeal of Spring Hill, Fla., allegedly owned two of the “purported” telemedicine companies, WebDoctors Plus and Integrated Support Plus. Federal investigators allege these telemarketing companies sold the prescriptions to the medical equipment companies, who, as part of the scheme, fraudulently billed Medicare for the braces. The U.S. attorneys allege the money made from the scheme was hidden through international shell corporations and used to buy luxury real estate, exotic automobiles, and yachts.
Even with the recent federal busts, the scams continue. And they’re not isolated to durable medical equipment. A $2.1 billion scheme was busted by the DOJ in September which involved telemedicine doctors authorizing unnecessary genetic tests. A DOJ press release names five companies to watch out for: Video Doctor USA, AffordADoc, Web Doctors Plus, Integrated Support Plus and First Care MD, as being involved in alleged telehealth and durable medical equipment marketing schemes.
What You Should Do If You are a Victim of a Telehealth Equipment Scam
The US Department of Health and Human Services recently issued a fraud alert about the nationwide brace scam. These are some of the tips they suggest if you are a victim of a telehealth equipment scam:
• If you receive a call from someone offering you a free brace that will be billed to Medicare, hang up immediately.
• If medical equipment is delivered to you, don’t accept it unless it was ordered by your physician. Refuse the delivery or return it to the sender. Keep a record of the sender’s name and the date you returned the items.
• Be suspicious of anyone who offers you free medical equipment and then requests your Medicare number. If your personal information is compromised, it may be used in other fraud schemes.
• A physician that you know and trust should approve any requests for equipment to address your medical needs.
• Medicare beneficiaries should be cautious of unsolicited requests for their Medicare numbers. If anyone other than your physician’s office requests your Medicare information, do not provide it.
• If you suspect Medicare fraud, report it.
Planning to Protect Loved Ones
Protecting seniors from scams is very important, which is why we continually share information about current scams and how you can protect yourself. It is also very important to plan for your future and to help plan for the future your loved ones. If you or your loved ones have not done Incapacity Planning, Estate Planning, or Long-Term Care Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long- term care, please contact us to make an appointment for a no-cost introductory consultation.
Elder Law Attorney Fairfax: 703-691-1888
Elder Law Attorney Fredericksburg: 540-479-1435
Elder Law Attorney Rockville: 301-519-8041
Elder Law Attorney DC: 202-587-2797
About Evan H Farr, CELA, CAP
