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News10NBC pulls back the curtain on a massive Medicare fraud

April 11, 2019 07:02 PM

ROCHESTER, N.Y. (WHEC) -- News10NBC is pulling the curtain back on what the feds call one of the biggest Medicare fraud schemes ever. We're going to show you the tactics used to get seniors to fall for it. 

The feds say the scheme involves kickbacks and bribes and convincing senior citizens to order medical supplies they don't need.  

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Twenty-four people got arrested across the country this week. 

News10NBC was in a viewer's home when another telemarketer called. We want to show you how it worked so if the call comes to you or your parents, you're prepared. 

Three boxes in 10 days. 

"I don't know what to do with it. I don't know who to call," Linda Little said holding up a back brace. 

In the last 10 days, three boxes of medical braces got delivered to her home in Rochester. This is what happens in the Medicare fraud scheme the FBI busted up this week. 

The deputy inspector general for the Department of Health and Human Services says it starts with a phone call. 

"They can be anywhere," Gary Cantrell said. "Literally, it's just a phone call."

And one of those calls came to Little's house when we were there. A computertized voice said this was an "urgent" call, Little's "final notice." Then the voice threatened that if Little didn't act now "Medicare will likely make you ineligible for coverage."

So she pressed one and a real person came on the phone. Within 15 seconds, he asked if she was in pain. 

"Yeah, I have pain but I didn't request any assistance," Little answered. 

From threats to opportunity

The caller said Little probably filled something out online. 

And then, the threats turned to opportunity. The caller told Little "they're supplying medical support braces at no cost to you as long as you have Medicare Part B. So that's the good thing," the caller said. 

"Are you a doctor?" Little asked. "You said you would go through a triage report."

The caller replied he would pass Little's pain information to a doctor and then a doctor would call her back. He said, "then they write the prescription for the braces and that's how Medicare ships them to you."

The kickbacks

"So these doctors are alleged to be paid kickbacks in order to write these prescription or orders for this equipment," Cantrell said. "And and they're not seeing these patients, they may be talking to them over the phone but um as alleged, these conversations are minimal at best."

Back at Little's house, the caller asked for her Medicare number. That's when News10NBC cut him off. 

"I just want to jump into the phone conversation here," News10NBC Chief Investigative Reporter Berkeley Brean said. 

The caller refused to say his name, who he worked for and how he got Little's number. Brean told him Little's doctor never prescribed medical braces. 

"And now, she's getting a call from someone she doesn't know asking if she's in pain and she's already got three boxes of this stuff sitting on her table," Brean said. 

The caller said he didn't know that. Then he said, "the fraud is on her side, not the other way. Have a good day."

If you, your parents, or your grandparents feel they've been defrauded, you should file a complaint.

Click here to find the complaint form. 

Here is the transcription of the phone call from the medical equipment telemarketer: 

Nancy: "Hi, this is Nancy your patient advocate working closely with Medicare. This is an urgent message for all patients on Medicare. This is your final notice. If you do not act soon Medicare will likely make you ineligible for coverage."

Recipient pressed one and got a real person who did not say his name or who he worked for but said he was responding to her request for assistance for chronic pain.

Caller: "Are you still having pain Linda?"

Linda: "Yeah, I have pain but I didn't request any assistance."

The caller said she may have filled out a survey online or something like that regarding pain. The caller asked her if she has Medicare.

Caller: "Okay, because the reason for the call is that they're supplying medical support braces at no cost to you as long as you have Medicare Part B, so that's the good thing. You wouldn't have to pay anything for the braces of the delivery to your home as well."

The caller asked Linda to rate her pain on a scale of one to 10. He asked her where the pain was, specifically asking if it's in her back, legs or arms. 

He said he was going to make a triage report and get braces for any part of her body.

Linda: "Are you a doctor? You said you would go through a triage report."

Caller: "It's just basic information. What happens is I give this information to the physician and they call you. And then, they write the prescription for the braces and that's how Medicare ships them to you."

The caller told Linda she doesn't have to go to the doctor.

He said, "they're going to contact you, okay?" and said it makes it "no inconvenience to you."

The caller then asked for the correct spelling of Linda's name, her date of birth and her Medicare card number.

News10NBC's Chief Investigative Reporter Berkeley Brean: "I just want to jump into the phone conversation here."

Caller: "Sure". 

Brean: "My name is Berkeley Brean. I'm an investigative news reporter here in Rochester, New York, and I was invited into Linda's home because she has received three boxes of durable medical equipment like back braces and leg braces but she doesn't feel like she's ordered them at all and now she's getting a call from you. How does this happen?"

Caller: "There's multiple companies that deal with this. That would be my answer for that. This is the first time that I'm contacting her personally."

Brean: "How did you get her number?"

Caller: "Either she provided it or somebody in her family provided it for her, having to do with issues of pain. She probably filled out an online survey, something like that."

Brean: "I just want to let you know again that I'm a TV reporter. I have my camera here and we're recording and we're recording everything. I guess the question is, Linda's doctor has never prescribed her any of this equipment so why would she need the equipment from you guys?"

Caller: "The medical equipment is provided by Medicare. It's not provided through us. All we do is check her eligibility to see if she does qualify and then the physician contacts her and sees if she needs it. That has nothing to do with me. I don't order anything. It's not a sales call. There's no selling of anything. This is just a benefit that's provided as long as they need it which is not up to me to decide that. "

Brean: "Her own doctor here in Rochester has never prescribed this stuff. And now she's getting a call from someone she doesn't know asking if she's in pain and she's already got three boxes of this stuff sitting on her table."

Caller: "Okay sir, but yet again, she never said any of that. That never came out of her mouth."

Brean: "Well, I'm telling you." 

Caller: "She should have said that in the beginning." 

Brean: "I'm telling you."

Caller: "I mean honestly, I'll just be very frank. If I was receiving a call and I already had the product or whatever they were supposed to be providing I would have said that very up front. Just briefly you know. Why would I waste my time? Yes, her doctor might not have prescribed them but that might not be his job. It's not his profession. At the end of the day, I don't know how she got three orders braces when you can only receive one every five years. So that's what I don't understand either. Why does she keep ordering braces if she already has them?"

Brean: "Where are you calling from?"

Caller: "The fraud is on her side, not the other way. Have a good day."

Brean: "Where are you calling from?"

When NBC Nightly News asked about the case, the feds pointed to the original story by the News10NBC investigative team.

Click here for our original story: Medicare mystery: Out-of-state docs and fast phone calls cost you billions 

Click here for our follow-up story: Feds arrest 24 in massive fraud scheme exposed by News10NBC 

Credits

Berkeley Brean

Copyright 2019 - WHEC-TV, LLC A Hubbard Broadcasting Company

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