Federal agencies probe medical-equipment fraud

September 29, 1991|By New York Times News Service HC

Federal officials and other experts say that unscrupulous companies are abusing the Medicare home health care program by selling elderly people millions of dollars worth of medical equipment they do not need.

Court records show that some suppliers have used aggressive sales tactics, including telephone solicitations; have induced gullible people to accept unneeded items; have submitted inflated, fraudulent bills to Medicare; and have filed claims through states that pay the most for a particular item, regardless of where the patient actually lives.

And the records show that some doctors have falsely certified a medical need for equipment.

Congress, the Department of Health and Human Services and a few states are trying to curb the abuses through new legislation, tighter regulation and prosecutions, and some companies are adopting codes of ethics and urging the government to set standards for certifying suppliers. But officials say the abuses remain widespread.

Medicare, the federal health insurance program for 34 million elderly and disabled people, helps pay for wheelchairs, bedside commodes, electric hospital beds, portable ventilators and countless other medically necessary items that doctors prescribe for home use.

The equipment has the potential to save money for the government by permitting frail elderly people to receive care at home, rather than in a hospital or a nursing home.

Changes in the Medicare program since 1983 have drastically shortened the average hospital stay, creating new demand for medical equipment that can be used at home.

Medicare spending for such equipment will total $2 billion in the coming year, out of a total Medicare budget of more than $110 billion, the Department of Health and Human Services estimates.

Spokesmen for the medical-equipment industry say most suppliers operate legitimate businesses. But Sen. Jim Sasser, D-Tenn., said Medicare's system of paying for home medical equipment was "so complex and confusing that it invites abuse."

A typical case is that of Charles E. Dohlmar, 71, who lives in a mobile home park near Tampa, Fla.

Mr. Dohlmar was skeptical when a door-to-door saleswoman insisted that the federal government wanted him to have an electronic device to treat his arthritis. "I got annoyed with her, she was so persistent," he recalled. But he decided to try out the device, which helps some patients. "She kept trying to tell me it was so good, but it didn't relieve my pain."

Mr. Dohlmar suspected a scam, and he was right. The company that supplied the device, a TENS (Transcutaneous Electrical Nerve Stimulater) unit, and the owner of the company later pleaded guilty to mail fraud.

Two doctors were convicted of prescribing TENS units for elderly Medicare patients without regard to whether the expensive equipment was needed.

Similar problems have been reported by private insurers. Thomas E. Desch, senior vice president of Blue Cross and Blue Shield of Illinois, said a family there was billed for rental of a hospital bed long after notifying the supplier that the patient had died. In another case, a man who rented a hospital bed for three days was charged for a year.

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