Feds, Medicare crack down on medical scooter fraud

WASHINGTON  The federal government is cracking down on medical-equipment providers who either overcharge Medicare for motorized wheelchairs or obtain them for people who don't need them, Medicare and Justice Department records show.

Medicare plans to almost triple the number of anti-fraud strike forces it operates nationwide, from seven to 20, U.S. Health and Human Services Department budget documents show.

So far this year, Justice has won the convictions of 16 people throughout the country who have defrauded Medicare for $57 million, records show. Another six people are being prosecuted now for running what federal prosecutors say is a nationwide ring that has bilked the government of at least $30 million.

Records from the Centers for Medicare and Medicaid Services show the cost of motorized wheelchairs to the government health service for senior citizens has risen from $259 million to $723 million, or 179%, from 1999 to 2009, the last year for which full records are available.

Advertisements for the wheelchairs, also called scooters, have exploded nationwide in recent years, as companies tout the improved mobility they provide and how Medicare, not the patients, will pay for the chairs.

A report released last week by Medicare's inspector general also showed that 61% of the motorized wheelchairs provided to Medicare recipients in the first half of 2007 went to people who didn't qualify for them. The inspector general found that Medicare is billed an average of $4,018 for a motorized wheelchair that normally sells for $1,048.

Scammers also exploit immigrant communities. In California, as English-as-a-second-language Medicare recipients line up for other services, a person will approach them in line and "They'll say, 'The government would really like for you to have a wheelchair,'" said Julie Schoen, director of special projects for California's Senior Medicare Patrol. Then, she said, the scammer will take the Medicare recipient to a "clinic" for an exam.

The patient will often receive a wheelchair, but not a motorized wheelchair worth about $3,600 for which Medicare will be billed, Schoen said.

Beyond fraud, there are several reasons for the increase, such as doctors who file wheelchair claims improperly, said Ellen Griffith, a Medicare spokeswoman.

Schoen says Medicare recipients end up victimized twice: If he or she doesn't receive a wheelchair but has been billed for one, Medicare won't provide a second wheelchair if that person ever legitimately needs one.

"It's a big problem," Schoen said. "The scammers really know how to do it well, but the guy with Parkinson's who needs a chair has to fight for it."

In South Dakota, people fall victim to television ads, said Melissa Wood, program director for Senior Medicare Patrol in South Dakota. The ads show seniors using electric wheelchairs to fish or visit a shopping mall, and tell them that, as Medicare recipients, they qualify for free.

"The people have no idea it's fraudulent," Wood said. "I think in the past year or so, it's picked up because of all the advertisements."

The scammers also collect people's Medicare numbers, which they then use fraudulently or sell to another company to use, Wood said.

To qualify for an electric wheelchair, Griffith said, a recipient must not be able to get around on his own — and a doctor must declare that a cane, a walker or a manual wheelchair is not enough to help the person get around. But in many cases, people go from not needing any equipment to needing a $3,600 wheelchair, she said.

Medicare is addressing the problem by placing guidelines online so providers can learn to properly document a claim, Griffith said. It has updated its payment policy, and increased claim reviews and previewing claims before payment, she said.