# Pitting the DME who are to blame for the health costs in the US **URL:** \ **Category:** The BBQ Pit\ **Created:** [April 1, 2017, 6:59am UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484 "2017-04-01T06:59:03Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![psychobunny](https://avatars.discourse-cdn.com/v4/letter/p/54ee81/32.png) [@psychobunny](https://boards.straightdope.com/u/psychobunny)\ **Post date:** [April 1, 2017, 6:59am UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/1 "2017-04-01T06:59:03Z")
Yes, you. You know who you are. You are the durable medical equipment providers whose apparent only goal is to scam Medicare. It started withe the commercials. “If you have Medicare, you may be eligible for a pain-relieving knee or back brace at little to no cost. Call now.” Unsatisfied with the response, you began to troll the nursing homes, looking for willing victims. Again, you promise “pain-relieving” knee or back braces and even heating pads. Who wouldn’t want a free heating pad? Who doesn’t have occasional back pain? Well, Medicare has been cracking down and now requires a detailed evaluation from the physician before they will authorize the supplies. That’s no worry to you, though, you just tell your patient, “We’ll take care of everything. We’ll send all the forms to your doctor.” They then bombard said doctor with the Medicare-required request forms. Should said doctor fill out the forms in a way that will not allow you to get your maximum reimbursement, there are no worries. You will simply instruct the physician in how to fill out the forms. If the physician notes (correctly) that the patient actually can walk without support, well, you just send the form back to them with instructions that she “needs” to document that the patient cannot walk without assistance (whether or not that is true). But that wasn’t enough. Apparently, patients are too ethical to volunteer for your schemes. So now you have taken it further. While my patient was on the telephone with you trying to get diabetic supplies, you informed him that he was eligible for a “pain-relieving knee brace”. When he told you that he didn’t want or need a brace, you persisted in harassing him until according to him, he allowed you to order it to get you to stop bothering him, at which time you then began to suggest he needed a back brace. This explains why I have been getting daily requests for Medicare justification for the braces that I haven’t ordered. Since the patient was going to be seen within a week, I held onto them, but you made sure to send a new request at least daily, even after I sent it back with a note to stop sending them. All I had to ask the patient was “I see that you were requesting a knee brace-are you having pain?” for him to come out with the entire story. This is actually not the first time this has happened. I have called Medicare patients before when I got the requests and been told that they really didn’t want anything but were being pressured to agree. So screw you for preying on elderly people to try to scam Medicare and for causing a ton of work for the already overworked primary care doctors. I have started to tell my patients to call Medicare and tell them what you are doing and I hope you get charged with Medicare fraud. And incidentally, not only do these braces not relieve pain, but they often cause additional muscle atrophy if used too long. I’ll treat my patients with physical therapy and appropriate medications, if you don’t mind, and keep them mobile and strong as long as possible. ---
**Author:** ![Hilarity\_N.Suze](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hilarity_n.suze/32/6223_2.png) [@Hilarity\_N.Suze](https://boards.straightdope.com/u/Hilarity_N.Suze)\ **Post date:** [April 1, 2017, 7:12am UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/2 "2017-04-01T07:12:46Z")
Oh, it’s even worse than the ads. I got a phone call. (This was about two months ago, right before I stopped answering the landline altogether unless I recognize the number.) I got a call from someone who introduced herself by saying, “I’m returning your call about the back brace you ordered.” Or maybe it was a knee brace. Anyway, I hadn’t ordered any such thing, ever, from anybody, nor have I seen a doctor about any knee problems, because I don’t have any! So I asked my husband. He hadn’t either. Completely mystified. She was fucking not returning anybody’s call. When I said I hadn’t, she asked to speak to “the Medicare patient in the home.” So, apparently, she’s either got our actual ages or some kind of demographic information that tell her we’re the right age, and therefore subject to annoying telephone calls for shit we didn’t request. She hung up when I asked her where she got my number. I reported her number to the state Do Not Call line but they are toothless. ---
**Author:** ![shiftless](https://avatars.discourse-cdn.com/v4/letter/s/e9c0ed/32.png) [@shiftless](https://boards.straightdope.com/u/shiftless)\ **Post date:** [April 1, 2017, 2:00pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/3 "2017-04-01T14:00:43Z")
My mom got one of those electric cars a few years ago, totally free, even though she has almost no use for it. Last month two men visited to ‘upgrade’ the car: New batteries, new parts, all free again. All she had to do was say yes when they called and Medicare pays for everything. Meanwhile, my 27 year old son pays into the ACA and Medicare then has to pay out of pocket for every medical need, however small. Yeah, there’s some serious imbalance in the way medical resources are distributed. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [April 1, 2017, 2:03pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/4 "2017-04-01T14:03:41Z")
You can have my scooter when you pry it from my cold, dead hands. > [@HNS](#): > > I reported her number to the state Do Not Call line but they are toothless. Don’t even get me started on the crappy dental coverage!! ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [April 1, 2017, 3:13pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/5 "2017-04-01T15:13:07Z")
So if we got rid of the scammy durable medical equipment providers in the U.S., health care costs would sink to reasonable levels? I’m on board with that. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [April 1, 2017, 9:19pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/6 "2017-04-01T21:19:11Z")
I have a “Medicare” CPAP. Instead of buying it outright, medicare RENTS it - at obscene rates. Bear with me… When I picked it up (Hi Apria!), a very young (having trouble growing a beard-type young) man was given the job of checking me out (make sure the confused old man can push a button). There was a massive contract to sign. A couple of weeks later, i get the same form with a note “Pls sign and return”. I figure “Medicare scam” and wait a week or so. Every 2-3 weeks i now get a “Copy for your Records” letter from Apria - it seems the date on the corrected contract does not match the date the machine was delivered. Claim Denied. They have appealed this at least 4 times and now are taking it to the Medicare Administer’s Appeal procedure. I half expect them to sue Medicare in Federal District Court and appeal to Supreme Court. I wonder how much they are spending on these appeals. ---
**Author:** ![Gatopescado](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gatopescado/32/5711_2.png) [@Gatopescado](https://boards.straightdope.com/u/Gatopescado)\ **Post date:** [April 1, 2017, 10:13pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/7 "2017-04-01T22:13:11Z")
I’m a Homebrewer, and DME means Dry Malt Extract to me. It’s used to make beer. Delicious beer. Yeah, I can see how it deserves pitting for health care costs. 😃 ---
**Author:** ![mhendo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mhendo/32/3159_2.png) [@mhendo](https://boards.straightdope.com/u/mhendo)\ **Post date:** [April 1, 2017, 11:41pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/8 "2017-04-01T23:41:45Z")
> [@Jackmannii](#): > > So if we got rid of the scammy durable medical equipment providers in the U.S., health care costs would sink to reasonable levels? > > I’m on board with that. Yeah, while i’m on board with the rant against the scammers, i doubt that they constitute the major reason for America’s astronomical healthcare costs. I wonder, for example, if the OP has hospital privileges, and/or uses a medical billing service like the ones described in a recent [New York Times](https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html) article: > [@](#): > > Seemingly subtle choices about which code to use can have large financial consequences. If after reviewing a hospital chart of, say, a patient who has just had a problem with his heart, a hospital coder indicates the diagnosis code for “heart failure” (ICD-9-CM Code 428) instead of the one for “acute systolic heart failure” (Code 428.21), the difference could mean thousands of dollars. “In order to code for the more lucrative code, you have to know how it is defined and make sure the care described in the chart meets the criterion, the definition, for that higher number,” says one experienced coder in Florida… > > The coders who work for hospitals and doctors strive to bring in as much revenue as possible from each service, while coders employed by insurers try to deny claims as overreaching. Coders who audit Medicare charts look for abuse to reclaim money or fraud that needs to be punished with fines. Hospital coders teach doctors — and doctors pay to take courses — to learn how they can “upcode” their charts to a more lucrative level with minimal effort. In a doctor’s office, a Level 3 visit (paid, say, at $175) might be legally transformed into a Level 4 (say, $225) by performing one extra maneuver, like weighing the patient or listening to the lungs, whether the patient’s illness required that or not. > > \ > > The stealth battle between hospitals and insurers over bills for each hospitalization, office visit, test, piece of equipment and procedure is costly for us all. Twenty-five percent of United States hospital spending — the single most expensive sector in our health care system — is related to administrative costs, “including salaries for staff who handle coding and billing,” according to a study by the Commonwealth Fund. That compares with 16 percent in England and 12 percent in Canada. > > That discrepancy comes, in part, from the prolonged negotiations over payment and the huge number of coders, billers and collectors who have to be compensated. Somehow, i’m willing to bet that the amount of illegitimate income from medical equipment scams has less of an impact on my hospital bill than the structural billing practices described in this story. ---
**Author:** ![mhendo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mhendo/32/3159_2.png) [@mhendo](https://boards.straightdope.com/u/mhendo)\ **Post date:** [April 1, 2017, 11:50pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/9 "2017-04-01T23:50:44Z")
I should add, by the way, that focusing on the OP in my previous post probably wasn’t fair. There are plenty of American doctors who are just as frustrated at the system as their patients. This will continue to be the reality, though, without the structural change of a single-payer system, or something similar. ---
**Author:** ![steatopygia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steatopygia/32/3132_2.png) [@steatopygia](https://boards.straightdope.com/u/steatopygia)\ **Post date:** [April 2, 2017, 6:03am UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/10 "2017-04-02T06:03:55Z")
This is the pit so I can swerve the bitch session a little. In my one emergency department, in one hospital, we see around 30% more patients than when I started. We have 20% more physicians, and 30% more nurses, and maybe 20% more ancillary staff. We have 4 times as much administration. I’m not exaggerating. From two to eight. Second topic. Electronic medical records or EMR. I helped initiate the first use of EMR in my hospital. It was a great and useful thing. Now, not so much. It has become much less of a way to have a transferable medical record than it started out to be. Now it is a way for hospitals to bill as much as they are able for each patient. Notice how much time your caregivers spend looking at a computer next time you are in the hospital. They are checking boxes that the 250% increase in administration has created. ---
**Author:** ![mhendo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mhendo/32/3159_2.png) [@mhendo](https://boards.straightdope.com/u/mhendo)\ **Post date:** [April 2, 2017, 7:04am UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/11 "2017-04-02T07:04:49Z")
> [@steatopygia](#): > > In my one emergency department, in one hospital, we see around 30% more patients than when I started. > We have 20% more physicians, and 30% more nurses, and maybe 20% more ancillary staff. > We have 4 times as much administration. I’m not exaggerating. From two to eight. It’s similar in higher education. I teach in the California State University system, and in the decade between 2004 and 2014, we saw a significant increase in students, which was met by the folks in charge by a _decrease_ in full-time faculty, and a significant _increase_ in the number of administrators, especially in higher-end positions with six-figure salaries. Here in San Diego, at San Diego State University, they added 7 Level-4 and 10 Level-3 administrators (the two highest levels) in the 2009-2010 academic year. This was the height of the financial crisis, a year when faculty hiring freezes were put in place, and faculty were required to take a 10% pay cut through unpaid furloughs. ---
**Author:** ![steatopygia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steatopygia/32/3132_2.png) [@steatopygia](https://boards.straightdope.com/u/steatopygia)\ **Post date:** [April 2, 2017, 7:32am UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/12 "2017-04-02T07:32:58Z")
> [@mhendo](#): > > It’s similar in higher education. > > I teach in the California State University system, and in the decade between 2004 and 2014, we saw a significant increase in students, which was met by the folks in charge by a _decrease_ in full-time faculty, and a significant _increase_ in the number of administrators, especially in higher-end positions with six-figure salaries. > > Here in San Diego, at San Diego State University, they added 7 Level-4 and 10 Level-3 administrators (the two highest levels) in the 2009-2010 academic year. This was the height of the financial crisis, a year when faculty hiring freezes were put in place, and faculty were required to take a 10% pay cut through unpaid furloughs. My brother teaches at Humboldt. We commiserate. Here is an article from his local paper in 2015. > **[HSU Has the State's worst Faculty Tenure and Salary Numbers](https://www.northcoastjournal.com/Blogthing/archives/2015/03/27/hsu-has-the-states-worst-faculty-tenure-and-salary-numbers)** > > A new report released from the California Faculty Association indicates Humboldt State is among the worst schools in the California State University system when it... ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [April 2, 2017, 4:18pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/13 "2017-04-02T16:18:56Z")
> [@Gatopescado](#): > > I’m a Homebrewer, and DME means Dry Malt Extract to me. It’s used to make beer. Delicious beer. > > Yeah, I can see how it deserves pitting for health care costs. 😃 Ah, blithe spirit, wort thou never brewed! ---
**Author:** ![Corry\_El](https://avatars.discourse-cdn.com/v4/letter/c/ecae2f/32.png) [@Corry\_El](https://boards.straightdope.com/u/Corry_El)\ **Post date:** [April 2, 2017, 4:43pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/14 "2017-04-02T16:43:15Z")
> [@mhendo](#): > > I should add, by the way, that focusing on the OP in my previous post probably wasn’t fair. There are plenty of American doctors who are just as frustrated at the system as their patients. This will continue to be the reality, though, without the structural change of a single-payer system, or something similar. Without generally derailing it into single payer debate, just on the point OP brought up it’s a little hard to see how that would necessarily be a solution. Medicare _is_ the ‘single payer’ part of the US system, and the ‘DME’ (also never heard that acronym before) are selling their stuff to it. The US could have much lower health costs (let’s put aside for a moment better/worse outcomes and _for whom_, that last part being politically key, not average outcomes or bad outcomes of certain demographic groups which pull down the average) with a single payer system that simply refused to pay for a lot of stuff Medicare now does, and/or dictated prices. But how likely is that? And I don’t mean ‘the Democrats have to win all the elections not the GOP’. When have the Democrats spelled out how much less stuff they’d provide than Medicare and how much less they’d pay doctors, etc? I haven’t heard that much. And the ACA wasn’t that much, just at the margins. Again really not to derail onto ACA or not, Trump and the GOP are all f\*\*\*ked up, etc. Just the simple point that Medicare is ‘something similar’ to single payer, for a limited pool of eligible people. But by definition it isn’t a solution to excessive costs in Medicare. ---
**Author:** ![Zakalwe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/zakalwe/32/270_2.png) [@Zakalwe](https://boards.straightdope.com/u/Zakalwe)\ **Post date:** [April 2, 2017, 10:55pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/15 "2017-04-02T22:55:26Z")
> [@mhendo](#): > > Here in San Diego, at San Diego State University, they added 7 Level-4 and 10 Level-3 administrators (the two highest levels) in the 2009-2010 academic year. This was the height of the financial crisis, a year when faculty hiring freezes were put in place, and faculty were required to take a 10% pay cut through unpaid furloughs. Well, duh! Who’s going to figure out how to cut all those costs? It’s the same logic that awards CEOs huge bonuses in the same year the company has massive layoffs. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [April 2, 2017, 11:01pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/16 "2017-04-02T23:01:13Z")
About 10% of the claims paid by Medicare are fraudulent. Last time I checked, that was about $50 BILLION per year, and yes, a lot of it is DME. :mad: That $50 billion would probably pay a huge percentage of the bills for un(der)insured Americans of all ages. ---
**Author:** ![nearwildheaven](https://avatars.discourse-cdn.com/v4/letter/n/90db22/32.png) [@nearwildheaven](https://boards.straightdope.com/u/nearwildheaven)\ **Post date:** [April 2, 2017, 11:02pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/17 "2017-04-02T23:02:59Z")
> [@shiftless](#): > > My mom got one of those electric cars a few years ago, totally free, even though she has almost no use for it. Last month two men visited to ‘upgrade’ the car: New batteries, new parts, all free again. All she had to do was say yes when they called and Medicare pays for everything. > > Meanwhile, my 27 year old son pays into the ACA and Medicare then has to pay out of pocket for every medical need, however small. Yeah, there’s some serious imbalance in the way medical resources are distributed. The Scooter Store (remember those commercials?) were basically a corporation founded to steal from Medicare. > **[The Scooter Store](https://en.wikipedia.org/wiki/Scooter_Store)** > > The Scooter Store, Ltd. (stylized as The SCOOTER Store) was a privately held provider of power mobility products, including power chairs (or motorized wheelchairs) and mobility scooters and related products and accessories, based in New Braunfels, Texas. The company served 48 U.S. states and the territory of Puerto Rico. > Following a raid by the FBI in February 2013, The Scooter Store filed for Chapter 11 bankruptcy and ceased all cash sales to the public. > Effective October 26, The Scooter Store... ---
**Author:** ![DoctorJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctorj/32/2904_2.png) [@DoctorJ](https://boards.straightdope.com/u/DoctorJ)\ **Post date:** [April 3, 2017, 5:01pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/18 "2017-04-03T17:01:51Z")
I throw these orders in the trash. If patients ask about them, I offer to send them to physical therapy for a real evaluation to see if they would benefit from a brace (spoiler: probably not). But the patients almost never ask about them. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [April 3, 2017, 5:07pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/19 "2017-04-03T17:07:41Z")
DME has been a mega-fraud and abuse industry for decades. When I worked for a Medicare contractor from the early 1990s through the mid- 2000s, our senior anti-fraud agent was a retired FBI agent. He busted so many DME scams. One that got thousands of people in Miami was the food-and-“inserts” program. At the end of the month, a few days before aid and SSI checks came out, people would go door-to-door with groceries and tell older folks that “Medicare wants you to be healthy and have this, we just need your Medicare card to write down the number.” Then they would ask if the people had foot pain, (of course they did) and they’d include “custom orthotic inserts.” They were not custom, they were basically Doctor Scholls. I loathe DME “providers”. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [April 3, 2017, 5:14pm UTC](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484/20 "2017-04-03T17:14:22Z")
You can get back and knee braces from any old drugstore for a price on the order of $10. Would I be right in guessing that these drugstore braces are just as effective, or very nearly so, as the expensive ones paid for by taxpayers? [Next page](https://boards.straightdope.com/t/pitting-the-dme-who-are-to-blame-for-the-health-costs-in-the-us/783484.md?page=2)