Recently, the Department of Justice, in coordination with Health and Human Services, announced that it had completed a massive sweep targeting Medicare telemarketing fraudsters nationally and internationally. Of the 24 defendants thus far, there are three doctors as well as chief executive officers. All in all the scam is alleged to have cost taxpayers over one billion dollars.
The telemarketing scam targeted the elderly, and basically sought to exploit individual Medicare benefits for kickbacks and durable medical device sales. Telemarketers would identify qualifying patients, then funnel them to particular telemedicine doctors, who would write prescriptions for various types of durable medical equipment, like knee, wrist or back braces. Those prescriptions would be filled by Medicare, often several times, resulting in kickbacks and illegal, fraudulent billings.
The scheme is alleged to have required some rather extreme coordination to pull off. Many of the telemarketers were based out of the Philippines and other countries, and would not only cold call individuals to see if they qualified, but were also using television and radio ads to solicit those who might qualify to call them.
After establishing a person qualified for Medicare, those individuals would be given tele-medicine appointments with real doctors who would prescribe the devices. Those scripts would be sold to the device company for $300, which would fill the prescription by sending the patient the proscribe brace and then bill Medicare, which paid the device company on average between $500 to $900.
Bracing for Fraud
Many of the senior victims of the scam actually filed official complaints, which tipped off the agencies to the problem, after receiving one or multiple unnecessary braces, or being targeted by one of these telemarketers. According to reports, investigators found that not only would the target of the scam have been sent multiple braces, sometimes identical ones, but often the braces were not actually need and sat unused.
If you think you may have been a victim of Medicare fraud, it is important to check your Medicare statements and keep track of your billed services to make sure they are indeed accurate. If you suspect something isn’t right, you may want to discuss the matter with a local, experienced attorney specializing in false claims act matters.