Justice Department sues alleging fraudulent claims in Medicare, Medicaid programs

Friday, April 29th 2005, 1:27 pm

By: News On 6

WASHINGTON (AP) _ The Justice Department announced Friday it is suing the Scooter Store, alleging the company submitted fraudulent claims to government health care programs to obtain reimbursement for power wheelchairs rather than much less expensive power scooters.

The New Braunfels, Texas-based company has billed Medicare for claims worth over $400 million since 1997.

The government's suit, filed in federal court in San Antonio, Texas, was a counterclaim to a complaint by the company, which is trying to overturn decisions by the Department of Health and Human Services disallowing hundreds of reimbursement claims for power wheelchairs in cases where HHS concluded the company failed to establish a medical necessity for the claims.

The Justice Department says the company engaged in a mass marketing campaign, assuring Medicare beneficiaries the scooters would be paid for by the federal health care program.

Once potential customers contacted the company on a toll-free number, callers were told Medicare would pay only for much more expensive power wheelchairs or that patients could not get a physician to approve the order for a motorized scooter, the lawsuit says.

As a result, Medicare and Medicaid paid for more expensive mobility equipment than the customers desired or needed, the government alleges.

The Scooter Store and four other businesses have undertaken a national lobbying campaign to challenge Medicare's new get-tough policy on reimbursements for power wheelchairs.

A year and a half ago, officials with the government health care program for 40 million older and disabled people ordered more scrutiny of claims for power wheelchairs, whose prices range from $5,000 to $6,000 or more, depending on accessories. The program ordered its insurance contractors to enforce strictly a policy that normally limits reimbursements to those unable to walk.

When a Medicare beneficiary wants a motorized wheelchair, a supplier evaluates whether the patient would be likely to qualify for the program's 80 percent reimbursement.

A supplier that believes the claim might be rejected may provide the chair only if the beneficiary signs a form agreeing to pay.