The Scheme: Medicare beneficiary receives a phone call stating their doctor has approved them for a knee brace and is asked for their Medicare number. Knee brace will be mailed to them. Beneficiary receives an item they assume is correct.
The Fraud: The company bills Medicare for two “adjustable knee joints, positional orthosis with rigid support,” but they send the beneficiary neoprene knee braces.
Medicare’s approved amount for the neoprene product is – $144. 88
Medicare’s approved amount for the knee joints is – $840.50
Dollars stolen from Medicare = $695.62