CHICAGO (CBS)–It’s a huge multimillion dollar scam and taxpayers are footing the bill. Maybe you’ve had a call offering you a leg or back brace — for free.
Only, it’s not free because, as CBS 2 Investigator Pam Zekman reports, we are all paying for it.
“I’d just done something horrible,” recalled Donald, who didn’t want to disclose his last name.
Donald had received a call from someone supposedly from Medicare wanting to make sure he had gotten his new Medicare card.
In response to questions Donald said, “I rattled off my Social Security number and then I realized, oops, I shouldn’t have done that.”
He says when they started asking more questions, he realized it was a scam.
Then he received follow-up calls, telling him braces had been ordered for him.
Calls like this one that says: “… you may qualify for a knee or back brace at little or no cost to you.”
“I said to them, ‘This is a Medicare scam and you guys are criminals, do not send me anything,’ and I got very angry with them,” Donald said.
Donald told CBS 2 that he did not need a brace.
In fact, Donald is in very good shape and jogs on a regular basis, and even though he refused shipment of the braces, Medicare still paid $3,236 in taxpayer dollars for five braces that Donald didn’t need and never received.
“Which is shocking to me,” Donald added.
Here’s how the scheme works.
Once the caller has your Social Security or Medicare number they get a doctor to sign off on a prescription for a brace –sometimes after a telephone examination. The caller then sends the order for the brace to one of several fulfillment companies located around the county.
We talked to a couple of doctors who signed off on these type of prescriptions, they say they get paid about $30 for each phone consultation, but deny being part of any scam. The doctors told us they were under the impression the patients had requested the braces.
“Right now, currently the medical supplies phone scam are the biggest one in the state and across the country,” said Travis Trumitch, from Age Options, a senior citizen advocacy group that helps report Medicare fraud.
Donald reported his case to the Medicare fraud hotline at Age Options.
“[It’s] very sad to see these companies are trying to defraud these innocent people here, and it’s a crime so we need to be on top of it,” Trumitch said.
Patients aren’t the only victims here. It’s all of us. A 2012 Inspector General Report revealed that taxpayers overpaid $37 million for back braces alone.
It’s unknown how much money has been wasted in total on unwanted braces.
But, a 2016 report shows that Medicare paid out almost $2.5 billion for prosthetics and orthotics, including braces.
Mabel Fowler has been inundated with calls after she was tricked into giving out her Medicare number. Then the boxes started to arrive.
“I’m surprised,” said Fowler. “I feel like it’s Christmas getting a package and I open it and I see all this.”
Over the course of four weeks she received 10 braces, including back braces, arm braces and leg braces.
Fowler said she is concerned that Medicare is paying for the braces and told CBS 2 that she did not order them and does not use them.
Medicare has already paid $4,389 of taxpayer money for the braces.
But it gets worse. We found similar braces online for just $1,163, 73 percent cheaper than what Medicare paid.
Fowler says it is a wast of taxpayer money.
About half of that money — $2,200 — went to a supply company in New Jersey called Matawan HME incorporated. They refused repeated requests to explain Fowler’s order.
All this begs the question: Why didn’t Medicare suspect something was wrong before approving payment for all these braces for just one person in four weeks?
In Fowler’s case, many of the braces don’t even fit and she never received any instruction on how to use them.
“It’s too complicated and it’s definitely not something she could do on her own,” said Amber Arnette, Fowler’s caretaker.
Arnette says she can hardly believe how many braces Fowler has received.
“If she needs braces, her doctor would call and order them,” said Arnette. “And her doctor hasn’t said anything to me or to her.”
We asked another doctor, an orthopedics expert about Fowler’s case.
“For a patient to be prescribed multiple braces for multiple body parts, without an adequate physical examination or traumatic event, sounds basically ridiculous to me,” said Dr. Charles Bush-Joseph of Rush University Medical Center.
Dr. Bush-Joseph has never treated Fowler, but her story is all too familiar to him.
“Patients are getting braces that they don’t really need and a third-party provider is collecting on them and the taxpayers like myself are footing the bill for this,” Dr. Bush-Joseph said.
How does this effect everyone?
“Well down the road premiums could increase for Medicare,” Trumitch, of Age Options, said.
And fraud like this threatens the very future of the Medicare program.
Donald still can’t believe he got taken.
“I feel violated is what I feel. I have the same feeling I felt when I was robbed once,” he said.
Both Donald and Fowler have filed complaints with Medicare and the Inspector General’s office.
Spokeswomen for both agencies said they could not comment on whether something is or is not under investigation. But they are concerned about any fraud and lapses in their systems that do no catch it.
If this has happened to you, please contact CBS 2 Investigator Pam Zekman at firstname.lastname@example.org.
Tips from Medicare to avoid Durable Medical Equipment fraud:
— Don’t accept anything over the phone and send back any braces you didn’t request
— If you need a brace talk to your primary care doctor
— Enter your phone number on the Do Not Call Registry https://www.donotcall.gov
— Medicare will NEVER contact you uninvited for your Medicare number or other personal information
— Call 800-HHS-TIPS (800-447-8477) or 1-800-MEDICARE (800-633-4227) to report fraud