06/18/2026    Paul Kesselman, DPM

I am a Medicare Fraud Victim

For the third time in the last year, my Medicare
number was billed for DME equipment I did not
order, was not prescribed, had no use for and
NEVER RECEIVED! Twice last year, I was billed for
continuous glucose monitors, despite the fact that
I am not diabetic. One CGM provider was paid, the
other was nailed with a same or similar denial and
not paid. I reported that to Medicare and In
December 2025, my account was billed for
approximately $4,000 in upper extremity and back
braces. I have since changed my Medicare number
and so far, so good.

As physicians, we have several obligations; at the
very least to both provide the best care we can in
the most ethical manner possible. One other
obligation is to ensure that the way that care is
paid for is preserved for future generations. In
my opinion, these are both sacred duties.

It is imperative that we or a staff member remind
our patients of these obligations at every visit.
We too, who are patients, must practice what we
preach. That is to check our Medicare statements
on a regular basis.

My problems are that it frequently takes too long
for the Medicare contractors to mail the EOMBs to
their beneficiaries. Or like most beneficiaries, I
am not vigilant enough about checking my Medicare
online account more frequently (I already do it at
least monthly. Apparently, that’s not enough).
For DME claims, braces should not be dropped
shipped. AOPA, APMA and others have supported this
Federal legislation, Unfortunately, Competitive
Bidding only allows a small number of DME
companies to dispense certain OTS braces, hence
the problem.

At the very least a DME company outside of NY
(e.g. New Hampshire or Indiana) should raise a red
flag to CMS. Those claims should not be paid by
the Contractor until some further proof that the
service(s) was/were actually provided.
Until some better solution is found, I urge those
who are Medicare Beneficiaries to check your on-
line accounts at least weekly. Report suspicious
claims to the 1800Medicare Number. If you have had
more than one suspicious claim, have your NMBI
changed. It’s not that big a deal and your
deductible information, secondary insurance and
Same and Similar information will easily follow.
Don’t discard the old number as the AI robots on
the 1-800 Medicare number can’t find it and you
will need to provide it to the human you
eventually are transferred to.

The most painful part of the process is that when
the customer service rep is just about finished,
they have to read through a five-minute script
about the Medicare fraud investigations, the
contractors, all of which we know. But the nice
part is that for once when you call an insurance
company, the call will not be adversarial, they
will be really nice, and they will thank you for
calling!

Am I the only physician who is a victim of
Medicare fraud! I know I am not. Let’s hear from
more of you.

Paul Kesselman, DPM, Oceanside, NY

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