FORT LAUDERDALE, Fla. — More than 60 percent of power wheelchairs Medicare buys for seniors were not needed or not right for the patients, wasting about $100 million in a six-month period, a July federal report found.
Take the Jazzy unit that has become a $4,500 armchair in Marvin Rosen
‘s Coral Springs, Fla., living room for three years.
Rosen, 81, said he wanted an $800 replacement for a scooter that helped him get around the house because he can’t walk well. A supplier told him the power chair would be bigger and better. His doctor signed off, and since Rosen’s supplemental policy covered his copayment, he didn’t pay a dime.
Within days, he could see the chair is too big to pass the doorways or maneuver in his house. The company hadn’t measured beforehand, as required. The chair is not to be used outdoors. The company wouldn’t take it back because he missed a three-day return period he said he didn’t know about.
“I ended up with a chair that was useless to me. I sit in it sometimes to watch TV. What a waste,” Rosen said. “These salesmen are a fast-talking group. That’s their come-on. They tell you it’s for your benefit. Make it easy to buy, and then you can’t give it back.”
Rosen’s tale was not unusual, said the recent report from the inspector general of the federal Health and Human Services Department. In a review of Medicare power chair sales from 2007, the agency found 61 percent were not medically needed or not documented by doctors and suppliers as being necessary.
Those seniors should have received less costly aids such as scooters, manual wheelchairs, walkers or canes, Inspector General Daniel Levinson told a congressional panel last week. Medicare obtains about 175,000 power chairs per year, costing $723 million in 2009.
Medicare has had problems for a decade with suppliers pushing expensive power chairs that were not needed, as well as outright fraudulent billing. Past reports found Medicare was paying almost four times the average $1,048 that suppliers paid for power chairs.
The findings led to a 10 percent cut in payments and stricter rules, such as barring seniors from getting power chairs unless a doctor documents they are too weak to get around the house with other aids.
Also, on Jan. 1, South Florida and Central Florida were among nine metropolitan areas to test a controversial new system for power chairs and other medical equipment.
Suppliers must pass accreditation to weed out phony firms. Only a select number of firms won the right to supply the items, based on bids. Seniors, through their 20 percent copayment, and Medicare now pay 25 percent to 30 percent less for power chairs, typically less than $3,000 here.
Wheelchair dealers insist the new rules and the new system have mostly solved the problem of bad deals and unnecessary, overpriced power chairs. They call the latest federal report out of date, misleading and an unfair slap at their industry.
“As far as being a joy ride like it was last year for some of the stores, it isn’t any more,” said William Perlman, co-owner of Medical Supply Depot west of Delray Beach, Fla.
“If you can walk from the bedroom to the kitchen, you’re not going to get a power chair. You can’t get one just to use in the mall,” Perlman said. “Trust me, anybody who gets a power wheelchair from Medicare truly needs it.”
Most of the 2007 power chairs called unnecessary in the federal report were just lacking paperwork, said Mark Leita, a vice president at The Scooter Store in Texas, among the biggest and best-known power chair dealers nationwide.
“We are all very careful about getting it right,” Leita said.
The Scooter Store in 2007 repaid the government $4 million and agreed to forgo $13 million in Medicare payments to settle a federal complaint alleging improper power-chair billings.
Federal officials involved in the report said they are not persuaded that the power chair problem is solved, and more reviews are planned.
In Florida, more than half of seniors’ complaints about suspicious Medicare bills in the first three months of this year involved medical equipment such as power chairs, said officials with the Senior Medicare Patrol, a program that enlists seniors to watch for fraud.
Some of the cases involve suppliers altering records so people qualify for power chairs when they really don’t, said Leo Scarpati, a Miami Gardens, Fla., consultant working for the program.
“The doctors or sales people will put it to them as a benefit to them. ‘Wouldn’t you rather be in a chair where you can be independent?’ That’s the key: selling independence,” Scarpati said.
In another situation, a South Florida woman could not get a power chair prescribed by her doctor because a company had previously billed Medicare falsely for a chair using her name, Scarpati said. It’s a problem that’s cropped up all over the state.
At least five Miami-area suppliers have been jailed in the past 18 months for falsely billing Medicare for power wheelchairs and other equipment, federal court records show. The companies collected $3 million by billing for equipment the patients didn’t need and never received.
In one case, DME Enterprises Group in Hialeah, Fla., collected $537,000 for power chairs and equipment in the name of Medicare patients who were dead, owner Ricardo Pascual admitted in a guilty plea. He was sentenced in December to five years in prison.
New wheelchair cases have slowed in the past year, as unscrupulous suppliers switched to items under less scrutiny, said Omar Perez, a Miami assistant special agent in charge of investigations for the federal health and human services agency.
Perez said the lull may be misleading. Federal agents in South Florida are mainly focused on firms involved in phony billing and have less time to investigate cases where wheelchairs are sold under questionable circumstances.
Seniors can protect themselves by being skeptical of sales agents’ claims and by checking every Medicare statement listing their medical care, to look for possible fraudulent bills or errors, said Makeba Huntington-Symons, statewide manager of the Medicare senior patrol.
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