We have all seen an increase in direct-to-consumer advertising from pharmaceutical companies over the last several years. Now, durable medical equipment suppliers are getting in on the act. This can be done via the various forms of media. However, recently I learned of another way that patients are engaged: directly by phone.
As a family physician, many things cross my desk each week, the most common forms being FMLA (family medical leave act) documents, disability forms, records releases, and prior authorizations, just to name a few. Recently, I received a request from a company for a back brace for one of my patients. I didn’t recall seeing the patient recently. I reviewed the chart and noted that I had neither seen him recently nor ordered a back brace. I called the patient to inquire about the order and learned that while he was on the phone reordering his diabetic test strips, the person with whom he was speaking asked if he ever gets back pain. Like most people, he informed them he did. They then advised him that he could get a back brace paid for by Medicare. That is when I became involved. They sent me the form; however, I did not complete the form and returned it with a note indicating that an office visit is required. They continued to send me a new form every couple of weeks. I have received other such requests, as well. One was from a compounding pharmacy informing me that my patient was requesting a compounded cream of 4 different medications for pain. She had never specifically requested this but was prompted in a similar situation.
While direct-to-consumer advertising by pharmaceutical companies has been present for years, this new tactic irritated me much more. If I were to sign that form without truly assessing the patient, I might potentially be participating in Medicare fraud. As stated in the Social Security Act section 1834(a)(17)(A), it is illegal for suppliers of durable medical equipment to make unsolicited calls to Medicare beneficiaries. The law states that the beneficiary must give his or her written permission, or the supplier must have furnished one covered item to the beneficiary over the last 15 months. This is where the direct-to-beneficiary unsolicited “cold call” to my patient came in. They had been supplying him with glucometer test strips; therefore, what they did was legal, even if less than admirable.
It is prudent to be alert for forms from potentially aggressive suppliers of durable medical equipment. Just about everything that Medicare authorizes has explicit coverage criteria; therefore, I always have the patient come in so that I can obtain a proper history and conduct a physical examination to support the request. To simply sign a form out of haste could potentially open the door to a visit from the Office of the Inspector General.
The take home message? Be careful what you sign.