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An Unlikely Case of Medicare Fraud



Ironically, Medicare payments for penile pumps have risen by more than 500 percent in the last ten years. Federal fraud investigators have been challenging the legitimacy of payments for many of these devices.

The Center for Medicare and Medicaid Services reports that annual expenditures for these pumps went up from $7.2 million in 2000 to more than $36 million in 2011. The government has uncovered rampant fraud associated with the devices. An Illinois supplier bought sex toy penile enlargement devices from cheap Internet dealers, and he sent them to Medicare patients who did not ask for them. They were all diabetes patients, and he lied to them by stating that the device would help with their bladder issues. He billed Medicare for the penile pumps at an increased markup of nearly 11 percent.

Two Florida firms collected more than $28,000 for 75 penis pumps that they sold to both male and female patients who were on Medicare. They never actually shipped any of the devices. These enormous billings are undoubtedly what sparked the investigations.

Read: The Benefits of Having the Appropriate Medical Cover

Medicare classifies the pumps as medical equipment. They do the same for wheelchairs, bedpans, and home oxygen tanks. If a physician prescribes the pump as equipment that is medically necessary to treat erectile dysfunction (ED), Medicare will pay for the device. Over the last ten years, the average cost for each pump has been approximately $338. Of course, the Medicare/Medicaid program does not cover sex toys; they only pay for medical penile pumps.

It was once theorized that the cause of ED was likely psychological and not physical; this theory has since been discarded. Doctors now believe that if a male cannot perform sexually, it’s usually attributable to a physical condition. The more common physical conditions that cause ED are vascular disease and diabetes. Since the doctors pay in the cases of patients with ED who have diabetes, thieves are targeting people with diabetes.

Because the underlying reasons for ED have changed, it has made it easier for unscrupulous dealers to steal from the Medicaid and Medicare programs. Fortunately, the government has been prosecuting these cases in court.

The Illinois above supplier, Gary Winner, was prosecuted and sentenced to three years for his crimes. He was also ordered to pay $2.2 million to the government for the fraudulent claims. The Winner case is only the latest in numerous fraudulent allegations being investigated by the government.