The Department of Justice continues to aggressively pursue people who are committing Medicare Fraud as it pertains to Durable Medical Equipment. DME as this equipment is called are back, knee, shoulder, and elbow braces. Other products that are being sold where Medicare Fraud is being committed are pain cream, Cancer test kits, and cardiac panels.
Here is how the fraud is committed. A sales organization will contract offshore call centers, in India, Pakistan, Mexico, and the Philippines to call senior citizens and solicit these products. They will gain the information from the senior, including tier medicare id number, and then check for same and similar This will tell them if the senior already owns the product and if he is eligible for coverage. Once they pass the same and similar they need a doctor to prescribe the product. In many cases, the doctor never sees the patient and is paid a kickback for prescribing the product. Once a call center lands a senior citizen as a client for one product they call them for all of the others that can be covered by medicare. It is not uncommon for a sales organization to make 20,000-25,000 from one senior citizen.
When the leads are sent to the sales organization from the offshore call centers they are in 3 forms. A posted lead has all the information with a recording of the call. A live transfer of the senior or doctor’s orders. The doctor’s orders or DOs as they are called have all the senior’s information including a prescription from the doctor. The call centers are paid anywhere from 200-2000 per lead. Many of these organizations are located in South Florida. I spoke with a former industry leader who is a convicted felon in this area, and he said many people selling these products that are paid by Medicare in South Florida are getting their attorneys prepared to defend possible charges. The recent arrest in Boston, Miami, and Jacksonville show the DOJ is not slowing down in this area.
