Fed-up doctors, patients can help cut Medicare fraud

Sen. Claire McCaskill is collecting info about medical equipment sales pitches
2013-05-01T00:00:00Z Fed-up doctors, patients can help cut Medicare fraud Arizona Daily Star
May 01, 2013 12:00 am

The following editorial appeared Monday in the Kansas City Star :

Kathleen Kennedy, a Chesterfield, Mo., internist, had seen enough. Faxes sent to her office requested authorization for medical equipment and testing products her patients didn't want or need. One patient reported badgering sales calls over several days. Medicare would have paid the bills, had she obliged. But she wasn't about to let taxpayers foot unnecessary bills.

So she started writing complaints: to her U.S. senators, state officials and federal hotlines. Attached to her letters was evidence - faxes from out-of-state medical equipment providers seeking her approval.

Her letter caught the attention of U.S. Sen. Claire McCaskill of Missouri, who last week led a subcommittee hearing on financial and contracting oversight exposing the problem of aggressive medical equipment sales calls to senior citizens.

The calls add to waste in the financially challenged Medicare system. Two private medical equipment providers - among those that sought Kennedyís signature - were invited to appear but were represented at the hearing by two empty chairs.

McCaskill, who has made her mark in the Senate addressing waste in federal contracting, is frustrated and wants answers. "There doesn't seem to be the hyper-focus on squeezing fraud and waste out of the Medicare system," she said. "We have a crisis. For every dollar put in the system, people take out $3."

As the baby boom generation pushes into Medicare eligibility, the cost surge could swamp the economy.

Her goal is to push the federal government harder to stop sending dollars to the "bad actors and clawing back money when they've ripped us off."

The problem is appallingly evident in TV ads. Electric scooters are "free," as are sleep apnea breathing machines. Just not free if you are a taxpayer.

The two no-show companies reportedly have collected $140 million in four years from Medicare. It irks McCaskill that they could take that kind of money out of the program and think it's "OK to not show up for an oversight hearing." Her plan: Push Medicare to save $1 billion in inappropriate payments in the next two years.

The problem Kennedy reported flips the usual doctor-directed prescription process on its head. Normally a doctor writes a prescription and the patient fills it. In for-profit, scam-operations, the prepared prescription originates from the equipment seller.

Medicare has estimated that up to 66 percent of durable medical equipment claims are faulty. That includes those with incorrect paperwork, not all abuse. But McCaskill has asked for more specifics, and she hopes public scrutiny and more whistle-blower tips will ratchet up pressure within Medicare. She's soliciting stories from those who have been hounded by sales pitches at whistleblowers@mccaskill.senate.gov

Since last year, cold-call sales of medical products to seniors have been banned. But companies with a prior sale or contact with a patient are exempt. Some try to pressure patients to accept more gear. McCaskill said the law may need to be broadened to stop unsolicited email and text sales, too. Bonds now required of medical equipment providers offer one path for the government to recoup inappropriate charges.

Fraud problems in the industry include "up-charges" in coding by equipment providers, goods charged but not delivered, and kickbacks to doctors for referrals or services.

Internist Kennedy is a powerful example for other doctors. As she wrote to authorities: "I would appreciate it if you would investigate these companies and hopefully put them out of business." More fed-up physicians and consumers would help save dollars and medical supplies for those who truly need services.

Copyright 2014 Arizona Daily Star. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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