WASHINGTON -- Dr. Charlotte Kennedy first became suspicious earlier this year when she received a fax from a medical supply company asking her to authorize a back brace for a 92-year-old patient.
The doctor from Chesterfield, Mo., had recently examined the patient, who'd never mentioned any back problems. In fact, the woman was an avid gardener. "She's picking up sweet gum balls in her yard every day," Kennedy said. But the fax said the woman had requested the brace, so Kennedy called her.
"Oh, Dr. Kennedy," the woman said. "They have been calling me every day for two weeks. I don't need it. I don't want it."
Kennedy soon began noticing more unsolicited faxes, for everything from diabetic testing materials to power scooters. When she checked with her patients, they said they hadn't requested any of the supplies. "I just don't think it's right," Kennedy said.
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As it turns out, she'd stumbled on a problem that cost Medicare -- and taxpayers -- $27 billion over the past four years. Now, thanks in part to the doctor's vigilance, companies that aggressively market pricey home medical supplies to senior citizens are facing increased scrutiny in Washington.
Kennedy fired off a letter to the Department of Health and Human Services, asking officials to investigate the companies that were sending the faxes. She sent a copy to Democratic Missouri U.S. Sen. Claire McCaskill, who opened a congressional investigation.
Within two weeks of a public query from the senator's office, more than 150 people complained about receiving harassing calls from medical equipment suppliers. One woman from southwest Missouri, Victoria Anderson, and her 87-year-old mother, Carroll Hughes, told McCaskill's staff that they get three or four calls a day from medical marketing companies even though they're on the National Do Not Call Registry.
Medical equipment suppliers are explicitly prohibited from cold-calling anyone enrolled in Medicare unless the beneficiary gave written permission or the supplier provided equipment to the beneficiary in the past.
From 2009 to 2012, Medicare paid $43 billion for durable medical equipment such as back braces, sleep apnea monitors and power scooters. More than 60 percent of those payments -- $27 billion -- may have been improper, according to research by staffers of a Senate subcommittee on financial oversight, which McCaskill leads. The federal government has been able to recover only about 3 percent of o
To fight fraud and waste, the federal Centers for Medicare & Medicaid Services have introduced competitive bidding and a pilot program that requires approval before Medicare will pay for power wheelchairs and scooters for beneficiaries in seven states with high rates of fraud and errors: California, Illinois, Michigan, New York, North Carolina, Florida and Texas, CMS spokesman Tony Salters said in an email. For now, pre-approvals aren't required in most states for most equipment.
Medicare officials say the agency also is taking advantage of tools in the new health care law, the Patient Protection and Affordable Care Act, to better screen suppliers and claims using state-of-the-art analytics to identify patterns of fraud.
In an interview after the hearing, McCaskill said those were positive steps but that they might not go far enough."It may be that some legislation is necessary," she said, though she didn't detail specifics. "I want to make sure that Medicare has the tools to stop this problem to bring down these costs."