The Scooter Store Sues CMS

NEW BRAUNFELS, Texas–The legal battle continued last week
between the country’s largest power mobility provider and the
federal government.

On May 27, The Scooter Store filed suit against CMS, contending
that the agency continues to “wrongly deny valid reimbursement
claims submitted in compliance with physician orders,” according to
a company statement. Earlier this year, the company filed a lawsuit
against the Department of Health and Human Services claiming the
government wrongfully denied hundreds of its power wheelchair
claims. That suit charges HHS with violating the law by demanding
additional documentation beyond a CMN to prove beneficiary need for
the equipment.

“The government should pay the claims that The Scooter Store
properly submitted,” said TSS President Mike Pfister. “We have
followed the law and physicians’ orders, and government contractors
seem to keep creating reasons to deny claims. As our complaint
shows, even officials within CMS have admitted that they have
violated the law as a result of their effort to drive down
utilization of the power mobility benefit.”

The company’s complaint alleges “that CMS contractors have
demanded that TSS and other suppliers routinely and regularly
supply them with volumes of information in addition to the CMN, in
violation of HHS’ own policies and the laws governing the Medicare
program.”

Stated Pfister, “The Congressionally approved certificate of
medical necessity was supposed to avoid confusion and bring
integrity to the Medicare program. Unfortunately, CMS’ present
approach is having the opposite effect.”

In a separate action, TSS has also filed a motion to dismiss
recent counterclaims filed by the Department of Justice in pending
litigation against the company. The DOJ’s countersuit alleges the
provider told potential customers who called the company’s
toll-free number that Medicare would pay for power wheelchairs but
not less expensive scooters.

The Scooter Store, which has more than 70 locations in 42
states, let go 400 employees last year, blaming the government’s
tightened power wheelchair claims policies. According to the DOJ,
the company has billed the government for more than $400 million in
claims since 1997.