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DME Telemedicine Scams

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  • Avatar ebotrd 
    Participant
    Status: Physician
    Posts: 14
    Joined: 10/25/2018

    Just went through one to see what exactly they ask you sign off on.  There is a section where you’re confirming that you did talk with the patient directly:

    Consumer Provided Answers, Must Be Verified By Assigned Physician
    Date the patient was called 10/25/2018
    Time call started:
    Time call ended:
    Treatment Goal:
    Consumer Provided Answers, Must Be Verified By Assigned Physician

    So, the sketchy part IMO is deciding the patient needs a brace/support without actually examining them – but that’s kinda true of all telemedicine.

    I will call one of the patients and confirm the history is true and maybe ask a few more questions, including whether they sought out this DME or were they solicited for it out of nowhere.

     

     

    #160086 Reply
    Avatar fatlittlepig 
    Participant
    Status: Physician
    Posts: 553
    Joined: 01/26/2017

    I recently started doing some moonlighting for a couple telemedicine companies.  The practice so far has been ordering DME (knee, ankle, lumbar braces etc).  My instincts kicked in after about 5 charts and I started to feel like these were scams.  The physician notes were entirely pre-populated.  In fact, there is only a small space to document any of my semi-required phone call to the patients.

    Has anyone else had experiences with these companies?  Specifically, RediDoc and Real Time Physicians.

    Click to expand…

    LOL. Are you that hard up for money.?

    #160094 Reply
    Avatar Anne 
    Participant
    Status: Physician
    Posts: 842
    Joined: 11/07/2017

    They sent me a “real” patient.  They have a PDF note all ready for you to sign off – SOAP all gathered by “intake rep”.  I could see gathering the subjective history for you, but the “Objective” they list there isn’t really observing anything except that the patient can walk. They say the pain is a 9 and worse by movement.

    Here’s a fully redacted example:

    Chief Complaint
    [Patient] has inquired about utilizing orthotic bracing for his current conditions; his chief complaint at the time of this assessment is: Back pain.
    Subjective Notes – Information reported by intake rep and patient test
    [Patient] described his pain as shooting pain  sharp pain, constant, ache. [Patient]’s back pain has been constant for over 5 years He has a fear of falling..[Patient]’s chief complaint is
    back pain, which is associated with a level of 9 on a scale of 1-10. The patient stated that movements aggravates the condition, temporarily resulting in higher pain levels. [Patient] has indicated that his pain restricts his ambulatory functions.
    Objective notes from treating physician
    My assessment of the condition of [Patient] today, a XX year-old was in regard to his complaint of back pain. [Patient] is ambulatory. This is a level 9 pain, but is made even
    worse when aggravated by movements. Based on my assessment, I consider this to be caused by instability and general weakness (ambulatory), due to a pre-existing condition
    resulting in the current level of pain and discomfort for an extended time.
    Assessment Notes – The diagnosis includes:
    M54.5 Low Back Pain,M62.81 Muscle weakness (generalized)
    Plan Notes – Doctor’s order from treating physician
    The benefits of the L0650, which is an alternative, non-invasive method to potentially relieve his back pain, has been explained to [Patient], who is interested in this treatment.
    Based on my assessment, I have determined it is medically necessary and appropriate to prescribe treatment today. For his complaint of back pain, I am prescribing this
    device: L0650. The first date He is authorized to start using the brace is the exam date, as signed, and should continue to use for 99 months/Lifetime. [Patient] or an assisting
    caregiver will be able to apply this brace with minimal self-adjustment as the L0650 does not require custom fitting.
    I feel the L0650 back brace will benefit [Patient] by helping address all of the following:
    Reduce Pain,Reduce pain by restricting mobility to the trunk,Support spinal muscles and/or deformed spine
    The patient will have the potential to benefit functionally from the AFO.
    The goals of this treatment plan hope to achieve the following:
    [Patient]has been provided with our telephone number to schedule a follow up brace evaluation, or if needed for questions. It is recommended that [Patient] consults with a pain
    management physician to discuss and control his pain management regimen. This brace evaluation is an additional pain management aid and not a substitution for [Patient]’s
    current treatment.

    They also send you an audio file of the interview to listen – sounds like a phone call, not in person.  Patient actually sounds slightly annoyed by all the questions/confirmation of information discussed (as one might with a telemarketer).  Patient only has to say yes/no – patient is not saying anything describing the pain or how it affects their function in the audio.  It doesn’t mention the info above that it’s been ongoing x 5 years or that “he has a fear of falling”.  Perhaps that part wasn’t recorded on the audio – only the summary(?)  Otherwise it does at least verify that the patient would like the orthotic and thinks it will help them.

    I could see patients rushed through their medical appointments and their aches and pains perhaps often not addressed by their PCP.  Then these RediDoc guys call them and ask if anything hurts.  Probably 80% of elderly Americans will say something hurts, right?  OK, do you think a brace/support might make that feel better?  It’s free.  I suspect most patients will say OK, why not.  Maybe some are helped by this.  I’m not sure what to think.  The Columbus Dispatch article mentions that these orthotics are very expensive for Medicare, but I’m not sure why they must be so expensive – Medicare should probably look into why their suppliers are overcharging for such items.  I wouldn’t be comfortable ordering 8 orthotics on the same patient, but one (maybe 2) seems reasonable and I don’t see any way this could harm the patient.

    Thoughts?

    Click to expand…

    You asked for thoughts, so I will give you mine.  There is very poor evidence for efficacy of long term use of lumbar braces for chronic low back pain, and can potentially contribute to worsening/over reliance/increased fear of movement/core weakness.  If you are managing the patient comprehensively with active rehab strategies, both physically and cognitively, and want to add prn bracing with education on proper use that’s one thing, but what is described above is wasteful at best.

    #160115 Reply
    Liked by Zaphod
    Avatar HikingDO 
    Participant
    Status: Physician
    Posts: 269
    Joined: 03/09/2017

    I recently started doing some moonlighting for a couple telemedicine companies.  The practice so far has been ordering DME (knee, ankle, lumbar braces etc).  My instincts kicked in after about 5 charts and I started to feel like these were scams.  The physician notes were entirely pre-populated.  In fact, there is only a small space to document any of my semi-required phone call to the patients.

    Has anyone else had experiences with these companies?  Specifically, RediDoc and Real Time Physicians.

    Click to expand…

    LOL. Are you that hard up for money.?

    Click to expand…

    Is this character just your shtick or are you really this much of an…..um, irritable person?

    #160132 Reply
    Avatar fatlittlepig 
    Participant
    Status: Physician
    Posts: 553
    Joined: 01/26/2017

    I recently started doing some moonlighting for a couple telemedicine companies.  The practice so far has been ordering DME (knee, ankle, lumbar braces etc).  My instincts kicked in after about 5 charts and I started to feel like these were scams.  The physician notes were entirely pre-populated.  In fact, there is only a small space to document any of my semi-required phone call to the patients.

    Has anyone else had experiences with these companies?  Specifically, RediDoc and Real Time Physicians.

    Click to expand…

    LOL. Are you that hard up for money.?

    Click to expand…

    Is this character just your shtick or are you really this much of an…..um, irritable person?

    Click to expand…

    Not sure what you mean. Fatlittlepig calls it the way Fatlittlepig sees it.

    #160140 Reply
    Liked by tex
    Avatar G 
    Participant
    Status: Physician, Small Business Owner
    Posts: 1390
    Joined: 01/08/2016

    I recently had to explain why I gave IV fluids to a septic patient to a CMS auditor via hospital billing dept.  (Don’t get me started, I feel like I just got my blood pressure down to the non-critical zone.)

    I would rather not be in a position of explaining why I ordered a back brace for a patient with an H obtained by someone else & P that I didn’t perform.

    It’s probably like speeding during rush hour–they can’t catch everybody.  But if it were me, I would pass on the DME telemed thing.

    #160145 Reply
    Liked by Kamban
    Avatar MrsIMDoc 
    Participant
    Status: Physician
    Posts: 194
    Joined: 01/09/2016
    Splash Refinancing Bonus

    I would consult a lawyer to try and rectify the 5 charts you have done. I know someone who got charged with medicare fraud for this even with just a few charts.  Now she can’t practice as an internist for two years (can’t bill medicare), effectively ending her career.

    #160146 Reply
    Avatar fatlittlepig 
    Participant
    Status: Physician
    Posts: 553
    Joined: 01/26/2017

    I would consult a lawyer to try and rectify the 5 charts you have done. I know someone who got charged with medicare fraud for this even with just a few charts.  Now she can’t practice as an internist for two years (can’t bill medicare), effectively ending her career.

    Click to expand…

    That’s disturbing.

    #160148 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 1703
    Joined: 01/15/2017

    Total scam on insurance.  Personal experience.  Wife has LBP and suppose that it was on a ICD10 coding and somehow this got out somewhere….so some company calls her up, asks a few back questions and sends her out a brace, some diclofenac for ‘free’.  After receiving them, I questioned her about it and she reviewed the above….lo and behold 2 weeks later, our insurance bill comes in the mail.  $500 DME — wow.  Crazy.

    Reported that to our insurance to keep an eye out for these claims.  While true LBP, it certainly didn’t warrant a brace that costs $40 on Amazon.

    #160156 Reply
    Liked by Kamban, Zaphod
    Zaphod Zaphod 
    Participant
    Status: Physician, Small Business Owner
    Posts: 5510
    Joined: 01/12/2016

    I’m just shocked how this kind of thing gets up and running, so big so fast. They will probably make a mint even after they get caught.

    This kind of waste we can do without before any of the other bs sold to us.

    #160159 Reply
    Avatar Kencufc 
    Participant
    Status: Physician
    Posts: 21
    Joined: 08/12/2017

    I found this as well.  No real follow up and I didn’t see anything come of it.  I googled the physician mentioned in the article.  He was a pain medicine specialist out of state to where the braces were sent.

    #160324 Reply
    Avatar Kencufc 
    Participant
    Status: Physician
    Posts: 21
    Joined: 08/12/2017

    I would consult a lawyer to try and rectify the 5 charts you have done. I know someone who got charged with medicare fraud for this even with just a few charts.  Now she can’t practice as an internist for two years (can’t bill medicare), effectively ending her career.

    Click to expand…

    Can you elaborate a bit on the nature of the fraud committed?  I do plan on consulting an attorney.  Even 5 charts scares me.

    #160325 Reply
    Avatar Kencufc 
    Participant
    Status: Physician
    Posts: 21
    Joined: 08/12/2017
    Earnest refinancing bonus

    I would consult a lawyer to try and rectify the 5 charts you have done. I know someone who got charged with medicare fraud for this even with just a few charts.  Now she can’t practice as an internist for two years (can’t bill medicare), effectively ending her career.

    Click to expand…

    That’s disturbing.

    Click to expand…

    The point to this entire thread is to raise awareness and let other docs know that this is a scam.  Ok, it took me five tries to realize but I did.  Wish I would have known better from the get-go.

    #160327 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 1807
    Joined: 01/03/2017
    The point to this entire thread is to raise awareness and let other docs know that this is a scam. Ok, it took me five tries to realize but I did. Wish I would have known better from the get-go.

    Click to expand…

    I feel like prescribing various braces for people that you don’t do an exam on is a pretty good indicator things aren’t on the up and up.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #160382 Reply
    Liked by RocDoc
    Avatar Jackmomma 
    Participant
    Status: Physician
    Posts: 26
    Joined: 01/26/2016

    I wouldn’t do it. Get out now.

    The exam in that H and P you cited has no real exam. What is the brace really trying to treat? The vast majority of LBP is muscular anyways. Bracing just makes things worse.

    We can go into further detail

    This is a level 9 pain, but is made even
    worse when aggravated by movements. Based on my assessment, I consider this to be caused by instability and general weakness (ambulatory), due to a pre-existing condition
    resulting in the current level of pain and discomfort for an extended time.

    How do you know its unstable? If was unstable I get it a brace is needed. At this point why are you even doing telemedicine? An unstable spine needs to be seen by an MD in person, like, asap. No imaging is done. No testing of gait, reflexes, appearance, strength etc.

    I don’t mean this as an insult but I’m surprised as an attending physician (I’m assuming you are an attending), red flags were not ringing after just 1 chart.

    Do a google search on Medicare fraud and ‘arthritis kits’. That tells you all you need to know.

    This is the big problem. As much as we seem to be trying to shift costs away from hospitals and doctors visits, this is the type of crap that spawns.

    I’m old school; I still believe in old fashioned face to face visits with a real physician doing a real physical exam. When it comes to back pain, physical exam is so, so important.

    #160462 Reply

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