PALM BEACH, Fla. — Florida’s dubious prize as Medicare fraud capital of the nation is forcing frail seniors here to endure extra hassles and delays when seeking scooters, power chairs or motorized wheelchairs.
Once beset with a fraud and inappropriate-use rate estimated at 60 percent, Medicare is taking aggressive steps to rein in the abuses in powered mobility sales.
Federal agents recently raided the Texas-based headquarters of The Scooter Store, the nation’s largest powered mobility seller, amid allegations of doctor-coaching and inappropriate shifting of scooter customers to more costly, higher-margin devices like power chairs.
Meanwhile, a new demonstration program singles out seniors in Florida, New York, Texas, Illinois, Michigan, California and North Carolina for a preapproval mandate. The new program requires claims for a powered chair or scooter to be submitted and OK’d before a scooter is delivered, not after.
Already, the 6-month-old measure has added delays of about a month, several Florida device sellers said. Medicare officials say the goal is to turn around the paperwork within 10 days.
Melissa Lopez is the health and wellness director at Abby Delray, a large assisted living and retirement community. A man with lung disease recently tried to buy a scooter — he had letters from his physician and physical therapist attesting to his need, but he still was denied, Lopez said. He’s appealing.
“It took a month and a half to two months to get it approved through Medicare, and it was denied, which was very surprising to everyone. Because he clearly had a need,” she said.
Others have been rejected. “Some have respiratory and other issues where they are just unable to walk from one area to another, and a scooter would help them. It’s been a struggle. It really has been,” Lopez said.
The newest austerity measure appears aimed at finding savings by forestalling inappropriate sales before they happen.
The blame for the shift falls squarely on those ubiquitous television advertisements: the ones showing bright-eyed seniors attending family reunions and waving from the edge of the Grand Canyon in their scooters; the black-screened ads asserting: “You may qualify for a power chair at little or no cost to you.”
Medicare pays for devices intended for home use only, and seniors must pay 20 percent unless they have supplemental insurance coverage. Before a senior can qualify for a Medicare-paid power chair or scooter, he or she must be so frail that he or she lacks the upper-body strength to even push a wheelchair.
Demand for the devices pushed Medicare’s payments for powered chairs and scooters from $259 million a year in 1999 to a peak of $1.2 billion in 2003.
Fraud control efforts, competitive bidding and reimbursement cuts brought the costs down to $723 million by 2009, the most recent figures available.
In 2011, the U.S. Centers for Medicare & Medicaid Services began requiring medical device dealers in much of the country to bid for the right to sell devices — like scooters — to Medicare beneficiaries. That move alone saved the program more than $200 million in its first year, the agency reports. Seniors benefited by lower out-of-pocket payouts, an agency spokeswoman said.
But collectively, the actions have made it more difficult for frail seniors to get their wheels.
To get a scooter or power chair now, seniors must first visit a doctor, and the doctor must write out a free-form statement, describing specifics of a patient’s health and mobility challenges. Then, the patient must deliver the paperwork to a store that has won the right to handle Medicare claims for powered mobility devices.
Then paperwork goes to a Medicare contractor to review it and preauthorize the purchase, unless it’s the type of complex chair used by paraplegics and others who are severely disabled.
Bill Perman and Lou Toscano own the Medical Supply Depot in Delray Beach near a cluster of thousands of senior condos. They say their business has been booming since the federal raid on The Scooter Store.
The power chair giant is now unable to process new Medicare claims. Overnight, the Medical Supply Depot saw its scooter and power chair business surge from a few a week to more than 20, Toscano said.
“We’re helping a lot of people who were left in the lurch,” he said.
Medicare’s wheelchair and scooter benefit
If a patient’s doctor submits a written order stating a medical need for the patient to use a wheelchair or scooter in his or her home, Medicare will help cover it, if the patient meets all of the following:
• Health condition that causes difficulty moving around in the home.
• Unable to do activities of daily living (like bathing, dressing, getting in or out of bed or chair, or using the bathroom) even with the help of a cane, crutch or walker.
• Able to safely operate and get on and off the wheelchair or scooter, or have someone always available to help.
• Equipment must be usable within the home.
Source: Centers for Medicare & Medicaid Services