As Medicare payments for penis pumps have soared by more than 500 percent in the past decade, federal fraud investigators have challenged the legitimacy of payments for thousands of the devices. According to the Center for Medicare and Medicaid Services, annual spending on the pumps has gone up from $7.2 million in 2000 to more than $36 million last year, still a tiny part of the $7.5 billion Medicare spends each year on durable medical equipment and outpatient supplies.