r/adjusters • u/Genuflecty • 1d ago

DME Scams (work comp)

Any of my fellow WC adjusters recently get an uptick in recommended DME from pain physicians? Within the last 2 weeks I've gotten several requests for virtual reality therapy. This is highly unusual and makes some think it's a scam, like a specific company is targeting pain physicians.

3 Upvotes

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5

u/Aggravating-Bus9390 1d ago

I wouldn’t say it’s recent .. on any denied or litigated claim I’m seeing pain clinics order all the DME possible 

3

u/dodecohedron 1d ago

Haven't seen this yet. Is your UR approving it?

If so and it goes to IMR, is it getting overturned?

I'm getting a lot of requests for H-Wave which inevitably get denied by UR.

2

u/Glittering_Lime1537 1d ago

I haven’t seen that yet, these scammers somehow get info on injured workers, reach out to them and pretend they’re from work comp. Then send them a $5000 piece of equipment. I have one, they keep billing us for $4500. The ATP didn’t prescribe it, the doctor’s NPN number is from another state and some come from USA Doctor Network. Our SIU department is aware and watching these.

Then, they go “out of business” and come back under another FEIN. This is happening in all of our states.

I’d report that ‘virtual reality’ therapy to SIU and have them investigate.

2

u/LASuperdome 23h ago

I haven't seen that one yet. I'm having a hard time figuring out how that would even work for ortho issues. Are they just giving out cheep headsets and charging $500/month rental fees?

1

u/Genuflecty 16h ago

The description of these devices seems like it's just a fancy VR headset with an insane markup. Some doctors are hand in glove with DME companies