Lifestyles over 50 Finance & Money
“Do you have Medicare? Do you have aches and pains? We can provide braces that Medicare will cover! How about a genetic testing kit to see if you are predisposed to getting cancer?” If you are like most Medicare beneficiaries, you or someone you know has received phone calls or other solicitations for these items, often several times a day. TV ads are also very effective at soliciting these products.
Braces are considered by Medicare to be durable medical equipment (DME.) They are only covered when medically necessary and prescribed by your physician. In one recent scam, a Pennsylvania resident was called and offered wrist and back braces. She gave her Medicare ID number to the caller, and a few days later received a box of cheap, over-the-counter braces that she didn’t need. But her Medicare was charged nearly $5,000 for the equipment. If you need any medical equipment, call your doctor first. Hang up on anyone calling to sell you these items. It’s almost certainly a scam and you could wind up having to pay out-of-pocket for the equipment. Genetic testing scams are also very common. The tests are presented as available and beneficial to a wide range of people, and companies often say that a person’s insurance will cover the tests or testing kits at no cost to them. Medicare does have a benefit that covers genetic testing for individuals that meet very specific criteria for these tests. Here are the facts:
The only genetic test that Medicare covers as a screening benefit without cost to the beneficiary is the colorectal cancer screening test.
Medicare covers other genetic tests as diagnostic services, meaning that by federal regulation the treating physician must order the test and use its results to manage the patient’s condition. The regulation states that any test that’s ordered by someone other than the treating physician is “not reasonable and necessary.”
Beneficiaries could be subjected to unnecessary services and potential out-of-pocket costs. Since the consumer’s insurance is billed, often with falsified claim information by physicians who have never seen the beneficiary, consumers should consult with their personal doctors first if they believe that a genetic test would be beneficial.
The PA Senior Medicare Patrol (SMP) at CARIE works to curb fraud and abuse in Medicare and Medicaid. If you need more information, please don’t hesitate to contact CARIE at 800-356-3606. Help is always free and confidential.