Sixteen months after the cessation of a concentrated effort to
crack power wheelchair fraud in Harris County, Texas, CMS is still
seeing a decrease in fraudulent claims, officials say.
“CMS has noted significant changes because of our efforts
to curtail wheelchair fraud in Harris County,” according to
Julia Lathrop, special assistant to the regional administrator for
CMS in Dallas. “The number of claims for power wheelchairs
dropped significantly, the claims denial rate is more appropriate
and a number of wheelchair suppliers' Medicare numbers were revoked
for various reasons.”
While Operation Wheeler Dealer officially ended on Oct. 1, 2005,
CMS and its contractors still “monitor wheelchair activities
in Harris County on a regular basis,” Lathrop notes.
While the number of claims for power wheelchairs is not
currently available, Lathrop cites these statistics:
Submitted charges in 2002, the year before Operation Wheeler
Dealer went into effect, added up to $154,774,372; by Oct. 1, 2006,
they had dropped to $20,150,712.
The total number of beneficiaries (billed) also dropped
dramatically, from 21,353 in 2002 to 3,354 in 2006.
She notes, too, that some HME providers lost their Medicare
supplier numbers: “The National Supplier Clearinghouse
completed its site visits to Harris County suppliers on Feb. 26,
2004. As of that date, the NSC had revoked 355 Harris County
suppliers.”
Lathrop adds that “CMS definitely believes that Operation
Wheeler Dealer was a success.”
The initiative was CMS' response to massive PWC fraud schemes
that came to light in Houston, which is located in Harris County.
Medicare paid more than 31,000 claims for power chairs in Texas in
2002 compared to 3,000 in 2001, officials said when Wheeler Dealer
was launched.
The agency put the 10-point initiative into place in September
2003. Among other things, the plan suspended issuance of new
provider numbers; required all payments for motorized wheelchairs
in Harris County to be scrutinized and approved by CMS staff on a
special task force; required the medical provider to see the
patient before prescribing a wheelchair or scooter; and targeted
power wheelchairs as the “first item analyzed for potential
inherent reasonableness adjustments.”
Harris County HME providers were also required to attend
training programs on CMS medical policies.
The program threw even reputable providers into an anxious
state. “Anything coming out of Harris County, you'd be
flagged,” says Marlon Boquin, owner of Bomar Medical Supply
in Houston. “Everybody across the board in Harris County
suffered.”
Boquin started out as a driver before opening his own HME
company six years ago. “I saw how some people were not using
power mobility in the right way,” he says, noting that he
would go to a wholesaler to pick up equipment and see other
companies picking up 15 or 20 power wheelchairs.
He's glad that many of the disreputable providers are gone, but
he believes some legitimate providers got caught in the crossfire.
“After this came down, we probably cut the DMEs in half or
more,” Boquin says, pointing out that some providers whose
business was concentrated on power mobility were soon out of
business.
“You can't put all your eggs in one basket,” Boquin
states.
Sandra Hoskin, owner of Houston-based American Medical Equipment
Co. in Houston and secretary/treasurer of the Medical Equipment
Suppliers Association, which serves Texas, was also happy to see
the fraudulent dealers disappear, but she's concerned that they may
be coming back.
“Operation Wheeler Dealer might have slowed it down for a
while, but I think it is all coming right back,” she says,
pointing out that while many of the fraudulent providers were shut
down and their owners put in jail, many new DME companies are
springing up. She questions those that appear to sell a lot of
POVs.
“Whenever I see anyone doing a lot of [power mobility
devices], it throws up a red flag. And it should to
Medicare,” she says.
Hoskin says her present business in power chairs is limited.
However, she adds, “I have learned you can get paid for one.
I had a person come in and she needed a POV, and she met every
single solitary requirement … I could not find one thing
Medicare could have denied it on. It was our test case. We didn't
have a problem. We weren't even asked for more
information.”
Now, she says, before filing a claim with Medicare for a power
wheelchair, she goes over every detail. “If it got denied,
I'd be mad. This way, if it gets denied, I can't be mad at
anyone.”
While Hoskin says legitimate providers that did strong business
in POVs likely lost a lot of money because of Operation Wheeler
Dealer, she does not think beneficiaries were hurt.
That perception is supported by CMS.
“The CMS Dallas Regional Office has not received any
complaints from Medicare beneficiaries regarding a shortage of
wheelchairs or suppliers,” says Lathrop. “To the
contrary, during OWD activities, CMS received numerous complaints
from Medicare beneficiaries and others regarding the over-abundance
of suppliers, wheelchairs and inappropriate activities.”
In the end, Lathrop says, Operation Wheeler Dealer was a success
on a regional level, and it also gave CMS ammunition to fight fraud
in other areas.
“There are a number of activities related to OWD that
could be replicated elsewhere, if needed,” she says.
“These include targeted medical review; on-site visits to
suppliers to identify non-existent or out-of-compliance suppers;
and training of suppliers and physicians on medical policies,
claims submittal and requirements for the particular
products/services.”
In other words, we may not have seen the last of Operation
Wheeler Dealer.
