'This happens all the time': TN couple hit twice by medical fraud — what to know about Medicare scams targeting retirees

'This happens all the time': TN couple hit twice by medical fraud — what to know about Medicare scams targeting retirees
Doug Leins thought something was off when he opened his Explanation of Benefits (EOB). The west Nashville retiree and his wife had been billed through their Medicare supplemental insurance for genetic testing that neither of them had requested, nor had their doctor.
"We knew for a fact that we had never requested that and that our doctor had never requested that," Leins told WSMV4 (1). "This fraud is just so rampant."
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Then it got worse. When the couple reviewed both their EOBs, identical charges appeared on each — from two different clinical labs, one in Arizona and one in Utah. When they called both numbers, neither was in service.
And because their supplemental insurance paid out the fraudulent claims, those amounts now count against the couple's annual coverage totals — potentially leaving them with less coverage for legitimate medical needs for the rest of the year.
Leins also faces a potential $1,329 out-of-pocket bill for testing he never received.
The fraud didn't stop there. Unsolicited medical equipment — two knee braces and a back brace — arrived at their door without any order placed. When Leins contacted the shipping company to report it, the response was unsettling: "They said, you know, this happens all the time" (1).
A wider scheme with a possible foreign connection
The Leins are far from alone. In a separate WSMV4 investigation, College Grove retired nurse Penny Vaughan and her husband discovered their quarterly Medicare statements showed more than $11,000 billed for urinary catheters over five months that they didn't need or order (2).
"We did not need, did not buy, did not order," Vaughan said. "Three hundred a month would mean you were catheterizing yourself 10 times a day. Nobody does that” (2).
The billing originated from two medical equipment suppliers — one in Florida, one in Texas. The Texas company's managing member, Nika Machutadze, is a Russian citizen living in Austin who has since been federally indicted.
According to the criminal complaint, his company submitted claims to more than 221,000 Medicare beneficiaries nationwide, billing the federal program more than $3 billion.