February 05, 2019 06:23 AM
CHILI, N.Y. (WHEC) -- News10NBC is investigating a Medicare mystery that costs taxpayers billions of dollars.
Patients are getting mailed boxes of equipment that they may not be able to use and you end up paying for it.
Neale Sweetman was trying to get Medicare to get him a new wheelchair. But what showed up in a box at his front door in Chili does him no good.
His family thinks he fell victim to a new kind of telemedicine where out-of-state doctors make fast phone calls and get patients to say yes.
Kathi Sweetman has the photos of the delivery that came to her father's house.
"So I believe this is a knee brace. [Another] knee brace," she said.
Those, plus a back brace, came in a large cardboard box last summer.
Inside the box were the itemized bills.
Kathi read the charges.
"On Aug. 15, charged Medicare $1,356," she said.
A second bill shows Medicare was charged another $1,500.
Neale Sweetman's insurance was billed at least $200.
"But I'm like, 'where did this come from?'" Kathi Sweetman asked.
It came from a medical supply company outside Tampa, Florida. The bills say the equipment was ordered by a doctor in North Carolina.
News10NBC Chief Investigative Reporter Berkeley Brean: "This doctor in North Carolina, has she ever seen your dad?"
Kathi Sweetman, daughter: "No."
Brean: "Has the doctor ever talked to your dad?"
Sweetman: "Was this doctor ever on the phone at some point with my father? I don't have the answer to that."
Brean: "Have you ever talked to her?"
Brean: "This medical supply company in Florida, have you ever order anything from them?"
Kathi gave News10NBC her father's phone records from last spring and summer.
Most of his outgoing calls were to family and friends. But we found two numbers that, when we called them, connected us to a pain management hotline in Buffalo.
The phone records show Neale Sweetman called the numbers twice in one day, five hours apart. But the calls lasted for only one minute.
"I believe that there were phone calls made to him and offering all kinds of things to him, which I don't think he really understood," Kathi said. "And at some point maybe he said yes."
"And this call center is kind of pushing, 'hey you can get this pain cream for free, don't worry about it. You can get this back brace for free, don't worry about it' and the beneficiary says yes," Reggie France said.
France is the assistant special agent in charge of the Inspector General's Office in the Federal Department of Health and Human Services.
His office investigates allegations of Medicare fraud.
News10NBC checked the federal database that shows arrests and indictments.
The doctor who authorized the braces for Neale and the company that supplied them are not listed.
France says there are organizations in this country that hire doctors to call older people to ask if they're in pain.
"We don't know specifically how they found Neale Sweetman but what we can tell you is in a lot of cases there are black market lists of beneficiary information that are being sold to these call centers," France said.
France says in a three-year period, Medicare was billed $6 billion just on pain cream prescribed over the phone.
Brean: "So who's the injured party here?"
France: "So the taxpayer because the beneficiary doesn't need it."
Neale Sweetman has never been prescribed knee or back braces by his primary doctor, Mark Mirabelli.
Brean: "Is it crazy that he would get knee braces and a back brace?"
Dr. Mark Mirabelli, Neale Sweetman's doctor: "Not crazy. But it's more the method of how he gets them that matters."
Doctor Mirabelli says he gets faxes to his office every week asking him to sign off on medical equipment for people on Medicare.
Brean: "Where do those faxes come from?"
Dr. Mirabelli: "They come from a variety of companies around the country. And they're often not, they're never local places."
Brean: "And what do you do with them?"
Dr. Mirabelli: "Well, personally, my practice is, I put them right in my recycling bin. I ignore them entirely. Some of these places almost become harassing that they'll bother our secretaries and they'll fax multiple copies of the same thing every single day until they get a response."
Brean: "If doctors are actually talking to recipients, like Neale, does that stop it from being fraudulent?"
France: "Telemedicine is supposed to work when a doctor is asking the right questions. When a doctor is doing some type of medical background on the patient. If the doctor is just calling and saying 'hey, can I confirm that you need this script' and you say 'yes', the doctor is not doing their job."
Dr. Mirabelli: "Even in those cases that are well-intentioned, that are not fraudulent, they may not be the best treatment for that patient. In other words, the patient may never have had a clinician actually look at the painful joint or problem that they have to diagnose what the actual problem is. Maybe it's not arthritis. Maybe, God forbid, they have cancer in that joint."
Cindy Gordon is the director of Telehealth for the Rochester Regional Health System.
Brean: "When it's done properly, the patient knows who they're talking to."
Cindy Gordon, director of Telehealth at Rochester Regional Health: "Exactly. "
Brean: "They can see the doctor. It's scheduled. There are no surprises."
Gordon: "Correct. It's all scheduled. You know who the provider is and in many instances, like we do in our own system, there's a nurse there with the patient."
News10NBC first spoke to that doctor in North Carolina in October.
When we talked to her again last week she told News10NBC she stopped working for the telemedicine consulting group.
When we asked her the name of the group, she told us she couldn't remember.
If you, your parents, or your grandparents feel they've been defrauded, you should file a complaint.
Click here to find the complaint form.
Updated: February 05, 2019 06:23 AM
Created: February 04, 2019 06:13 PM
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