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TexasTowelie

(112,084 posts)
Mon Jan 13, 2014, 11:04 PM Jan 2014

Medicare overpays by millions on erectile dysfunction aids, inspector finds


Medicare payments for "vacuum erection systems" are increasing, a new report finds.
(U.S. Department of Health and Human Services)


Medicare, the government insurance for people 65 and older, won’t pay for routine hearing aids.

But it will cover “vacuum erection systems.” Just get a doctor’s note.

I learned this today when the U.S. Department of Health and Human Services sent word that its inspector general had found “grossly excessive” payments for the systems.

The erection systems – known less formally as penis pumps – are eligible for coverage under Medicare Part B’s prosthetic benefit.

More at http://watchdogblog.dallasnews.com/2014/01/medicare-overpays-by-millions-on-erectile-dysfunction-aids-watchdog-says.html/ .
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Scuba

(53,475 posts)
1. I don't know what a penis pump costs, but $38M sounds like a lot of them.
Mon Jan 13, 2014, 11:09 PM
Jan 2014

Is this just the pump manufacturer scamming Medicare? There's about 24 million men on Medicare.

TexasTowelie

(112,084 posts)
2. Reading into the story it looks like it involves manufacturers and suppliers.
Mon Jan 13, 2014, 11:15 PM
Jan 2014

The $38 million figure is the difference between the price Medicare pays versus what the retail market charges.

KoKo

(84,711 posts)
5. For men who've had Prostate Surgery...it's an alternative to Viagra and the Rest...
Mon Jan 13, 2014, 11:23 PM
Jan 2014

But, it sounds like there is some scamming going on with these "pumps" that may be made in China but are being billed to Medicare for prices higher than the manufacturing costs plus profit.

Some don't realize that those who've had prostate surgery face the rest of their lives not able to function sexually. And these are many men in their 40's , 50's, 60's, 70's who don't have other medical problems, but unfortunately cannot have an erection because of the surgery.

So...it's not just old guys trying to "get it up" for a thrill .. It's men in relationships and those who hope to have relationships who can no longer function. And it leads to depression which has it's other downsides.

Same thing with the drugs like Viagra ....They aren't just for some guy who "wants to get it on when he feels the thrill." These drugs are expensive...(until they go off patent) and yet it's the only hope for many Prostate surgery survivors. The Pump is for when the drugs don't work and the pump or injections into the penis are the only alternative.

I have a family member who has gone through this and it's a terrible thing to have beaten cancer but not to be able to live a functioning life with his wife.

SoCalDem

(103,856 posts)
3. Didn't legislation pass that prevents coverage for the pills?
Mon Jan 13, 2014, 11:20 PM
Jan 2014

There are probably MANY men who cannot afford the pills on their own, so they are suddenly "trying" the only thing covered.. the pump.. .. My guess is that many of them order it, and then end up paying out of pocket for the pills anyway..and the pump ends up gathering dust under the bed..

csziggy

(34,135 posts)
11. While there are many who need these devices
Mon Jan 13, 2014, 11:38 PM
Jan 2014

The same as many need scooters or powered wheelchairs, a lot of the companies advertising on TV may be running Medicare scams the way the Scooter Store was. People who legitimately need devices to make their lives more liveable probably should not be relying on the companies who advertise on late night TV to make their purchases.

My post was not intended to criticize the users, just advertisers who I suspect of being scammers.

KoKo

(84,711 posts)
12. These Medicare Paid for Pumps are prescribed by Urologists....
Mon Jan 13, 2014, 11:48 PM
Jan 2014

as last resort. So while there maybe some folks buying them from TV Commercials...they are prescribed for Prostate Surgery Patients.

I've not seen these pumps advertised on TV...but, then I don't watch much commercial TV and imagine maybe late night there is some company selling something like that. As for the scooters...I've wondered how many people want to get one of those if they don't need it to get around. Would a fullying functioning person want to ride around in a scooter? So how much fraud could there be? The ability of an injured person no matter their age to be able to function in some way is worth our society trying to find a way to provide that help. And, yes...if the companies are overcharging then that can be investigated and should be restricted. But, not to blame the disabled but the companies gouging Medicare or for younger people their insurance companies.

Just saying....

csziggy

(34,135 posts)
13. There are plenty of doctors who will sign off on unneeded devices
Tue Jan 14, 2014, 12:07 AM
Jan 2014

And the companies that scam Medicare are happy to recommend doctors to prescribe things so they can sell their stuff.

The ad I see most often on late night TV is for the Pos-T-Vac. I googled the company name and found this:


Medicare-claims fraud suspected for penis pumps
By Stephen Dinan
The Washington Times
Tuesday, June 19, 2012

A new report by federal auditors says a Kansas-based company may have paid out as much as $4.2 million in potentially fraudulent Medicare claims for penis pumps, and the auditors are asking the company to refund the government the money.

The Health and Human Services inspector general said it sampled 100 claims made with Pos-T-Vac, the Dodge City-based penis-pump manufacturer, and found improprieties in more than half of payments for what are known as “male vacuum erection systems.”

The errors ranged from the company’s failing to maintain proof that it delivered the pumps to customers, to one instance when the physician’s approval order wasn’t even signed by the doctor.

Together, those claims from the small sample amounted to $18,007 in billings, and when multiplied across Pos-T-Vac’s entire set of 28,088 claims, the potential for fraudulent payments came to more than $4.2 million in 2008 and 2009, the auditors said.

Read more: http://www.washingtontimes.com/news/2012/jun/19/kan-company-suspected-42m-medicare-fraud-penis-pum/#ixzz2qLEC6RwQ


The Scooter Store used similar techniques for their scams and shut down last year after Medicare stopped paying for their products altogether:

The SCOOTER Store shutting down after federal scrutiny, CBS probe
September 14, 2013, 8: 54 AM
NEW BRAUNFELS, Texas A Texas-based company that sells wheelchairs and motorized scooters to people with limited mobility announced Friday that it is shutting down for good, following federal scrutiny over its advertising and billing and a CBS News investigation that shed light on questionable practices.

The SCOOTER Store, which filed for bankruptcy protection earlier this year, plans to phase out operations and furlough its remaining 370 employees and managers, the San Antonio Express-News reported, citing a company statement. The decision came from the company's board of directors.

The company's announcement comes after the U.S. Centers for Medicare and Medicaid Services notified The SCOOTER Store that it would lose its federal contract for reimbursement of the sale of its products, effective Oct. 26. The federal decision "effectively eliminates" its ability to sell its assets in a Chapter 11 reorganization, so it will liquidate, the company said in its statement to the Express-News.

The SCOOTER Store was one of the industry's leading companies, with TV ads promising freedom and independence to people with limited liability. But critics say the ads convince some seniors that they need a scooter to get around when many don't.

more: http://www.cbsnews.com/news/the-scooter-store-shutting-down-after-federal-scrutiny-cbs-probe/


Both types of devices have their uses and are needed by some people, but the ads convince people that are marginal that they need them, then push doctors to sign off on them. Then they inflate the charges to Medicare or insurance far beyond what the devices should cost.

I used a scooter for a short while before my knee replacement (mostly when I was attending a seminar at a large hotel). I bought it used from a man who had gotten it from Medicare. At the point I bought it, he could walk better than I could but he said he was being pushed to get a powered wheelchair but couldn't get approved as long as he still owned the scooter. That sounded a bit like a scam to me!

As I said, I am NOT criticizing the people who need the devices, just the companies that push the sales to those who don't really.

KoKo

(84,711 posts)
14. Indeed we agree on that. Get the fraud out..but, don't punish those many in need.
Tue Jan 14, 2014, 12:12 AM
Jan 2014

Unfortunately there will always be scammers...and the companies need to be investigated and the doctors prescribing. But, it's not the majority of people...and they shouldn't be punished or looked down on when they truly need some products that are prescribed.

Journeyman

(15,031 posts)
9. If we're spending that much on erections, somebody's getting screwed. . .
Mon Jan 13, 2014, 11:28 PM
Jan 2014

Gad, our priorities are all twisted up.

Sgent

(5,857 posts)
10. A little background
Mon Jan 13, 2014, 11:34 PM
Jan 2014

Penis pumps are covered as needed to treat a medical problem. Hearing aids are not covered -- but that's due to the fact that their is a specific exclusion in the law regarding hearing aids.

The IG's issue isn't that Medicare is paying for them, its that they are being overcharged. Here's how it works:

Medicare allowable for pumps is $350, and I'm a medical equipment distributor.

I setup a retail distribution system where I sell for $150.

I setup a second company where I sell them for $500, but only patients with insurance buy from company B. Therefore Medicare pays $350.

Net result is Medicare is paying $200 more than the "usual and customary" fee.

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