The SCTDD Area Agency on Aging & Disability reports that Medicare Zone Program Integrity Contractors have seen an increase in billing for orthotics in 2016, specifically for hand/wrist, knee, and back braces. AdvanceMed has found beneficiaries being billed for multiple orthotics by different suppliers, but the same referring physician.
The scam goes like this: First, beneficiaries are receiving phone calls from a marketing company. The marketing company asks the beneficiaries about their health and physical pain. The beneficiary is then transferred to a physician who talks to the patient and refers the patient for multiple orthotics. These phone calls between the physician and beneficiary are not billed to Part B as they do not meet the requirements of a telehealth visit. This scheme appears to be bypassing the Center for Medicare and Medicaid Services’ Marketing Guidelines that limit the ability of suppliers to market equipment and supplies directly to a patient.
Beneficiaries need to be on the lookout for phone calls from unknown parties regarding personal health information. If you get one of these calls, write down as much information as you can including the company and/or physicians name, address, phone number, etc. and contact the agencies listed at the end of this article.
• Health information should only be discussed with the beneficiary’s physician. • Medicare identification numbers and other personal information should never be given out over the phone. • Beneficiaries should be aware of suppliers billing for multiple orthotics and braces.
If you think you have been a victim of this type of Medicare fraud, call TN SMP [Senior Medicare Patrol] at 1-866-836-7677 toll free to report it. Or call your local SHIP office at 931-379-2927.
Souce: SCTDD Area Agency on Aging & Disability