Nov 29, 2010

A Heads Up About Durable Medical Equipment and the Change in Medicare Law

Do not assume your doctor or his staff will know!...
By Carole B. Larkin
Alzheimer's Reading Room

I wanted to alert you to a coming change in Medicare that could effect you now or in the future.

Medicare is starting a new program on January 1, 2011. This new program is designed to close the holes in the system that allowed for more than $60 Billion in fraudulent claims.

Specifically, the new law change I am referring to here will effect the purchase and rental of Durable Medical Equipment (see list below).
Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.

Prior to the change in law, Medicare paid just about any company that gave Medicare patients the equipment their doctor ordered for them. As of the first of next year, Medicare will pay only those companies that are approved for Medicare’s Competitive Bid Program. If you purchase or rent from a company that is not on the list you will not get reimbursed by Medicare.

Here is the list of cities and states where the program will be tested. In you live in, or have family or relatives that live in any of these areas, you should pay close attention.
  • California- Riverside, San Bernardino, Ontario
  • Florida-Miami, Fort Lauderdale, Pompano Beach, Orlando, Kissimmee
  • Missouri, Kansas- Kansas City
  • North and South Carolina- Charlotte, Gastonia, Concord
  • Ohio-Cleveland, Elyria, Mentor
  • Ohio, Kentucky, Indiana- Cincinnati, Middletown
  • Pennsylvania- Pittsburgh
  • Texas- Dallas-Fort Worth, Arlington

These are the kind of items that are called “Durable Medical Equipment” and must come from the new list of approved suppliers if you want to get them paid for by Medicare.
  • Oxygen, oxygen equipment and supplies
  • Standard power wheelchairs, scooters, and related accessories
  • Complex rehabilitative power wheelchairs and related accessories
  • Mail order diabetic supplies
  • Enteral nutrients, equipment and supplies (tube feeding)
  • CPAP (Continuous Positive Airway Pressure)equipment and RAD (Respiratory Assist Device) and related supplies
  • Hospital beds and related accessories
  • Walkers and related accessories
  • Support surfaces (group 2 mattresses and overlays) in Miami, Fort Lauderdale and Pompano Beach Florida only.

If you live in any of the cities or areas listed above, and are currently renting any of these items you may be able to stay with your current supplier if the supplier has been grandfathered in this Program.

Also, if you bought any of the equipment and need to have it repaired, make sure the repairer is Medicare approved first, otherwise you are on the hook (you will have to pay out of your pocket) for the rental cost and/or the repair cost.

What should you do before January 1, 2011 if you are planning to buy or rent any of the equipment before the new year? What should you do after January 1st if you have to buy or rent the equipment?

Call Medicare (1-800-633-4227) or go on to see if you are in a zip code that will be affected by this change.

If you are in the zip codes affected; find out which suppliers are approved suppliers by calling l Medicare (1-800-633-4227) or go on Both can tell you.

Do not assume your doctor or his staff will know!

Chances are they won’t know and could steer you to the wrong company.

You need to be PROACTIVE when it comes to medical care and medical equipment. It is better to be safe by checking, then to be sorry you didn't

If you don't check it could be money out of your pocket.

Also see

60 Minutes Medicare Fraud A $60 Billion Crime (Video, Text Transcript)

Carole Larkin MAG, CMC, CAEd, QDCS, EICS,
is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.

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Original content Carole B. Larkin, the Alzheimer's Reading Room