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Is this a scam by the provider?
#1
Hi All,
First of all I would like to thank you all for providing this board and giving me the ability to read my own data.
A little back ground, I was diagnosed with severe apnea during a sleep study a few months ago. I didnt want to partake in, what I considered a fraud done to Medicare by the providers charging a very much higher price for my unit than what I could buy it for in the open market but the reluctance of my NP to give me the prescription made me go through the recomended provider a few weeks ago.
The provider instructed me in the use of the ResMed S9 and told me to bring in the SD card after a month to show compliance.
I did ask if I could change cards myself but was informed that it was not readable by me.
Through the kindness of this board I have now downloaded the software enabling the reading of the card.
[i]And here is the big thing, the machine is almost a year old and have been previously used by somone from December 11 through February 12.
I cant for minute imagine that the provider is billing a used or refurbished unit but charging the full price again.
Is this a reportable scam to Medicare.
Should I point out to the provider that they "forgot" to erase a prior patient using the machine thereby owning up to using the software?
Or should I just live with it.
[/i]
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#2
Hi larsdahl, WELCOME! to the forum.! Hang in there for suggestions to help you with this situation.
trish6hundred
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#3
You are entitled by law to a copy of your prescription (and any other health records). Go back to your doctor and demand a copy.

I would suggest printing out a copy of your data showing the usage from the prior patient so you can confront your DME about not providing a new machine. Also notify Medicare about this.

You may get a tongue-lashing from your doctor or DME, but you have the right to choose a different provider. I would not do business with either of them in the future.

Edit: If your doctor is agreeable to your taking charge of your own care going forward, I wouldn't break ties with him solely because of his initial reluctance to provide you a copy of your prescription.
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#4
Lars,

I'm sorry to say that what is describe has been reported over and over again on this board. It's likely a machine from someone who either failed compliance (and had the machine repossessed) or who just gave up on the therapy and took it back to the DME.

Recommendation, go to the DME and raise hell! If you bought a new car and read the odometer and it had 15,000 miles on it, wouldn't you want the "new" thing you bought and paid for?

Again, there have been several stories of DME's that have apologized for their "mistake" and provided a new machine. There have also been several where the DME LIED and said insurance considers the machine new. The most successful stories usually involved perseverance and grit.

Go get em!

By the way, which S9? If they gave you one with "Escape" in the name, you have a different problem. The Escape machines only record usage (compliance data). You want the S9 Elite (CPAP) or S9 Autoset (APAP). These machines record therapy data, critical to you really knowing how effective the machine is. Same recommendation, if you have an Escape, get a new machine from the DME.
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#5
What I've read if its a rent to own agreement the DME doesn't have to give you a new machine during the rental period
You want full data capable machine that record efficacy data such as ResMed S9 Elite or AutoSet (Not Escape or Escape Auto)
PR System One Auto or Pro (Not Plus)
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#6
It must be an elite since it does record data which seems to tell me that the thing is working ok, at least the last couple of days. I have had some leak problems before that. Another question looking in the SD card using internet explorer shows only data for "my" period but when I open it up in the resscan software it does show those months in late 2011 early 2012. I dont know how that can be. Any ideas?

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#7
The summary data and the detailed data are stored in different files. My patient folder in ResScan contains a separate file for each day's detailed data. I used my machine for about two weeks before I obtained a data card; ResScan only has summary data for those days, and there are no individual files for those days. I think all the summary data is stored in one file. I use an S8 so I may have different files than you have.
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#8
If the data is AHI and leak than its S9 Elite and should say Elite next to start button
Here AutoSet model is shown
[Image: img_usage.jpg]

The S9 stores data up to 365 days and the SD card stores (AutoSet and Elite) 365 days of compliance data, 30 days of detailed data and 7 days of high resolution flow data
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#9
It's possible the machine is new, but they used an SD card that someone else had used previously.

There is a non-erasable "run hours" counter that will tell you how many hours the machine has run. It's under the menu you get to when you hold down info and setup for several seconds. Then go into the sleep report and scroll down.

Insurance usually requires you to rent the machine for the first few months. If you're renting the machine, it seems to me that you might reasonably expect to get a used rental machine. I'll bet it's legal and OK with medicare as long as they don't lie about it.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#10
I have Medicare. The machine they "rent" for me is the machine I keep.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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