Recent reports have shed light on the prevalence of Medicaid scams related to Durable Medical Equipment (“DME”).
On the one hand, the enduring nature of DME, which withstands wear and tear, makes it an easy target for illegal profiteering. According to sources from the Tampa Medicare Fraud Strike Force, the state of Florida has become a center for DME fraud. Since 2012, the federal law-enforcement has discovered over DME fraud amounting to $600 million across the nation, with Florida accounting for $58 million.
For example, the Medicare Fraud Strike Force has shed light on the connection between the rise of ‘scooter stores’ in Florida and Medicaid scams. These shops that grow faster than weed, are often the façade for illegitimate businesses, as they provide scooters to patients who do not really need them and bill Medicaid for unnecessary services.
Another way in which DME fraud manifests itself is through violent telemarketers who aggressively phone Medicaid patients tens of times a day to try to sell them medically unnecessary equipment.
The extent of Medicaid fraud in Florida implies a moral and logistical scandal, as it means that there is a large number of doctors who are willing to provide bad quality care to patients, a number of providers and medical practices who are also ready to participate in such schemes, and a vast population of vulnerable patients who become easy targets.
The lack of doctor-patient intimacy and close bonds, that is characteristic of telemedicine, is one more element that favors DME fraud, because physicians diagnose, prescribe medicine, and treat patients via video calls or phone calls without the need for a proper face-to-face encounter. This kind of detachment and aloofness helps in creating the right atmosphere for medical fraud. What was earlier used as a way to facilitate access to medical care and to smooth long waiting hours at the hospital or E.R. has now become an opportunity for patient abuse.
The recent investigation into the DME scandal has also revealed that patients’ names are sold on the black market, and fraudulent DME providers harass patients without any consideration. Whistleblower Daniel Yarbrough, who used to work as a manager of a medical supplier in Delray Beach, sued his former company for fraud and has painted a shocking picture of how easy it is to partake in this criminal scheme.
Yarbrough has revealed that companies may pay up to $20,000 per week for illicit lists containing thousands of Medicaid beneficiary names. Another whistleblower, Cody Fletcher, who worked for the same company as Yarbrough, speaks of how they would call those Medicaid patients non-stop. One of these Medicaid beneficiaries, Terry Combs, has testified about how he was sold a back brace he did not really need or want by a company that stalked him for over 12 months over the phone.
All in all, DME fraud is a billion-dollar uncontrolled problem. It is on the rise, and it will continue to put a heavy burden on the shoulders of the American taxpayer unless firm steps are taken to control it, prevent it, hold wrongdoers accountable, and, ultimately, protect vulnerable patients.