by Tom aka Rusty Rustbelt
HEALTH CARE: The Durable Medical Equipment (DME) mess
So you go to an orthopedic surgeon with a complaint of back pain, and the surgeon orders a lumbar back brace for support.
Can you stop at a counter and buy the brace on the way out the door? Probably not.
Years ago some members of Congress (Stark, Waxman, et.al.) thought it would be harmful if physicians profited from their prescriptions, but not harmful for others to do so, and thus has flourished a huge DME industry, ranging from hospitals and national chain pharmacies to mom-and-pop operations. (When I ran ortho centers we subbed out DME, too much hassle and compliance risk.)
Some DME providers get greedy and there has been a significant amounts of fraud in this area, most recently dealing with the ubiquitous motorized wheelchairs and power chairs of television fame.
But the latest DME fraud trend is really disturbing. DME fraud is being committed by phony “providers” who tend to be involved with organized crime, immigrant organized crime, computer hackers and identity thieves. These businesses do not exist, have no customers, provide no merchandise and steal billions from the feds with phony billings. Reading the indictments is enlightening.
(A few years ago nearly 50% of all of the diabetic supplies FOR THE ENTIRE COUNTRY were being billed from Miami – Dade County. Huh? Impossible of course. Miami appears to be a hot bed for immigrant crime.)
The feds caught on somewhat and set up a task force in southern Florida, and now are using the task force in Houston and possibly elsewhere.
Something here aggravates me. Getting a physician Medicare ID number, or adding a physician to an established group, takes a lot of time and a lot of paperwork, even though the physician is licensed and board certified. Apparently though any ambitious criminal can get a DME provider number with almost no hassle and start firing in billings. After a few months the operation closes down, takes the cash and billing starts for a new phony provider.
Medicare needs better management.
Tom aka Rusty Rustbelt