Durable Medical Equipment Fraud – Knee Brace

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

1833 knee brace example3
Actual item Medicare paid for but beneficiary did not receive this brace.
Item sent to beneficiary and paid for by Medicare
Item sent to beneficiary and paid for by Medicare
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