Is there a master dme abusers list for supplies

One of my bipap friends tells me he was shown a master computer file on himself that tracks customer use of cpap supplies. It tracks all your history and if you demand supplies on a regular minimum time schedule then you are rated as an abuser. He was in a doctors office at the time.
He was told any dme or medical office could access this list.
He is a fairly smart guy so I know there has to be a lot of truth to it. The only thing I can think of would be medicare online , your account shows every little lab test, dr- visit , dme purchase etc.
We need to know if there is such a thing and how it could impact us. If we buy supplies out of the system will that be a reason to deny us supplies because we were getting along without them before. That's how government thinks.
I am not an abuser but on the other hand I have a dme that says my machine filter is lifetime and he can only give me a new mask after 6 months because all his masks come with headgear. So I bought my own filters and masks at discount .
If he knew I was using software to download my machine he would freakout . He told me not to as it would erase the data in the machine . I know better and I'm beyond telling him anything . Don't try to impress the average dme they will just use it against you , play dumb.
This is not a complaint , I just want to find out how the system works and work around it.

I don't believe anything you have said. Your DME is feeding you a line of BS and I don't believe your friend has seen any such list. There are MEDICAL PRIVACY LAWS.

LSAT wrote:I don't believe anything you have said. Your DME is feeding you a line of BS and I don't believe your friend has seen any such list. There are MEDICAL PRIVACY LAWS.

I have to agree with LSAT on this one. "Abuser" has a lot of connotations. Buying too many or not enough supplies seems to me hardly to count as abuse. I think most DME's would be happy if you bought supplies on the regular basis suggested by your health insurance.

Until you have conclusive proof, I have to look at this with a skeptical eye. Frankly, it sounds a bit too much like the NSA phone record scandal to do anything but engender further friction between DME's and their clients on this forum.

My DME told me that I could only get a new 'tubing' if my old one had a rip in it. I was further advised about all the people who are abusing the system and getting unnecessary supplies, etc., etc.,. Everyone is being held accountable including suppliers and patients is what I was told. Nothing would surprise me about a master list somewhere. I'm not normally a 'conspiracy theorist'. I'm pretty sure I will go online to buy a new tubing. My current one doesn't have a rip in it but it kinks up a lot which is annoying. The nice 'slim line' tubing is really nice but way to much money so I'll get the big, clunky one and save myself some out of pocket expense.

LSAT wrote:I don't believe anything you have said. Your DME is feeding you a line of BS and I don't believe your friend has seen any such list. There are MEDICAL PRIVACY LAWS.

And they are constantly violated. I experienced this when I was on Prozac many years ago and thanks to CVS violating my privacy, I received some marketing notice from Eli Lilly.

Not to sound like a conspiracy theorist but what the OP mentioned wouldn't surprise me in the least.

49er

dme's do not tell you what you get. you insurance company tells you what they will pay for. speak to your insurance company. if there is a difference in what your dme and insuance comany tell you, put it in writing to your insuance company in the form of a complaint against your dme.

Just like there are no laws against changing your CPAP pressure -- the DME is feeding you a line of crap on said master list.

The only master list you need to be afraid of is Obama's drone list ... although unless your real name is Edward Snowden, there are a whole bunch of other people ahead of you ... right now.

Minimum Medicare replacement schedule does not allow for a person to the stuff to last until the replacement schedule for a a lot of us. Those who use low pressure and who are tolerant of leaks may have a different opinion.

I am perplexed about those who claim xPAP users stockpile supplies. Maybe some user who has a really fantastic insurance, but I feel sure that in the long run for a fantastic insurance which allows for oversupply, someone other than the insurance company is paying for all that stuff. Do not lump those of us who use Medicare guidelines for replacement schedule with those who are much better off.

I would feel those who claim we stockpile supplies should be willing to document their claims. We are not doing ourselves a favor by claiming the recipients are stockpiling xPAP supplies, when the replacement schedule, in my experience, is not frequent enough to cover the normal wear that causes us to need to replace supplies.

I already have to supplement the Medicare replacement schedule with supplies from cpap.com, plus I have a standing unpaid bill with my DME.

A DME only gets paid when product is billed to Medicare. DME's would be happy if we ordered more often. DME's are concerned whether we pay our bills on time. An insurance company might have a different aim, and a different reason to keep lists on patients who get everything on their replacement schedule. Insurance companies could/might use research for fraud as a reason to keep such lists.

There should be a master list of DME's who abuse patients!

Judging from what I've read here, the list of non-abusive DMEs would
be much shorter.

The OP stated his friend was shown a "master computer file on himself that tracks customer use of cpap supplies". That just sounds like either an insurance eligibility list or a business record of customer history. Whether it is the government with Medicare or any of the myriad of insurance providers, I would fully expect them to utilize technology to implement safeguards to watch for people who potentially could abuse the system. Let me be very clear what I'm saying. Receiving supplies as allowed by a person's insurance is not what I'm calling abuse. I know someone personally who says he has "a closet full of hoses" which upon further discussion means about a half dozen. He gave me one to replace mine that is over 2 years old and held together with tape. His provider had shipped them on schedule without request. For an insurance to take a closer look at a person who actually requests every supply on schedule could be a part of their fraud prevention safeguards. Reselling medical supplies can be big business. Just imagine if a patient claimed a dozen diagnoses (and we all know there are doctors who will oblige) and that patient requests every allowable item for every diagnosis. It COULD be an indicator of fraud. Personally, even with just my 20% copay it would have cost me more in doctor's appointments and testing to re-establish all of Medicare's criteria in a new location with a new doctor than to just buy outright. But if I look back a few years, if I had availed myself to every treatment option for my plethora of diagnoses and utilized every possible allowable item, I would have been an insurance company's nightmare, even though every bit of it would have been legitimate. And I would have a closet full of items to resell. Unfortunately, I do without some things I really do need because of the hoops I would have to jump through to get them. But I wouldn't worry too much about records showing I requested some items as allowed. I doubt that's what anyone who is watching is looking for.

As to the data being mined for WHATEVER purposes, I fully expect that it is. Information gathering is not a new thing, it's just that the means to do so has evolved.

knightlite wrote:One of my bipap friends tells me he was shown a master computer file on himself that tracks customer use of cpap supplies. It tracks all your history and if you demand supplies on a regular minimum time schedule then you are rated as an abuser. He was in a doctors office at the time.
He was told any dme or medical office could access this list.
He is a fairly smart guy so I know there has to be a lot of truth to it. The only thing I can think of would be medicare online , your account shows every little lab test, dr- visit , dme purchase etc.
We need to know if there is such a thing and how it could impact us. If we buy supplies out of the system will that be a reason to deny us supplies because we were getting along without them before. That's how government thinks.
I am not an abuser but on the other hand I have a dme that says my machine filter is lifetime and he can only give me a new mask after 6 months because all his masks come with headgear. So I bought my own filters and masks at discount .
If he knew I was using software to download my machine he would freakout . He told me not to as it would erase the data in the machine . I know better and I'm beyond telling him anything . Don't try to impress the average dme they will just use it against you , play dumb.
This is not a complaint , I just want to find out how the system works and work around it.

I'm with "kteague" (and others) on this one. I think it was only your friend's data. If he's using a large franchise (like Apria or Lincare), they probably have accessible databases in case the patient/user is in a different area and needs some supplies.
I've never used a brick & mortar DME and never will. I've acquired ALL of my supplies from online sellers, private parties and except for the initial equipment, all were purchased out-of-pocket. When I was working, I had a deductible that made it unrealistic to rely on my insurance to pay for stuff. So, every year, I stocked up on machines and supplies that averaged out to be less than the deductible.

I've seen some people who seem to rip off the system by getting more than they "need" and then I've seen it reported that some DMEs have shipped more supplies to the users than they (presumably) "need".........and are thus ripping off the insurance system.

It would appear that your DME is an idiot.


Den

.

There is probably some scientific means of tracking sale patterns showing possible fraud in obtaining DME supplies, etc. Either by Medicare and/or private insurance carriers -- and there darned well should be! Some people ("patients") abuse the system and go on to just obtain and re-sell their supplies on the internet. That's fraud and it should be stopped. We all pay for that kind of fraud.

How the fraud prevention methods actually work is a process that is known I am sure to a select few working for Medicare or the insurance companies.

And if telling folks there is a list that will bust unscrupulous people, as a tactic to help prevent fraud, then more power to them.

There's a secret government list that not even a tin foil hat will block!

So don't do it.

chunkyfrog wrote:There should be a master list of DME's who abuse patients!

Now that would be one long ass list.

knightlite wrote:One of my bipap friends tells me he was shown a master computer file on himself that tracks customer use of cpap supplies. It tracks all your history and if you demand supplies on a regular minimum time schedule then you are rated as an abuser. He was in a doctors office at the time.
He was told any dme or medical office could access this list. .

First of all any dme who uses a computer would have a record of what the client buys. I was writing software like that in the 70's. In business it is called sales analysis. If the doctor has a business relationship with the DME then the doctor could be linked in to their data base. Any other DME in the franchise can probably access it too. Of course the doctor is probably also computerized and keeps records of patient's activity- I wrote that stuff too in the 90's. And your insurance company has all those details too in it own databases.