Texas Dj Vu: Another Big Power Wheelchair Scam

Dallas

News of power wheelchair fraud returned to the Lone Star State in February when 11 Dallas-area residents, including DME dealers and a physician, were arrested in a multi-million-dollar Medicare billing scheme.

Unsealed Feb. 5 by the U.S. Attorney in the Northern District of Texas, indictments allege that the defendants submitted fraudulent claims for reimbursement of power wheelchairs and diverted the funds they received from Medicare for personal use. The U.S. Department of Health and Human Services said billings in the schemes were in excess of $36 million, with more than $15 million paid out by Medicare to the defendants.

According to the indictments, older individuals were often approached by recruiters who offered them free scooters in exchange for their Medicare information, which was then used to file the fraudulent claims. Some beneficiaries actually received scooters, but the suppliers billed Medicare for more expensive power wheelchairs, the indictment said. Other beneficiaries received written notification from Medicare that they had received a power wheelchair when, in fact, they had never asked for or received one.

Typically, Medicare was billed from $8,000 to $10,000 for the motorized wheelchairs. For each claim they submitted, the wheelchair suppliers would receive approximately $5,000 from Medicare, the indictment said.

The arrests were the result of a joint investigation called “Operation Roll Over,” which included law enforcement officers from HHS’ Office of Inspector General, Office of Investigations; the IRS’ Criminal Investigation unit; the U.S. Postal Inspection Service; the FBI; and the Department of Homeland Security, Bureau of Immigration and Customs Enforcement.

“We shut this operation down in four short months here in Dallas … and we’re on the lookout for any others even contemplating a similar scam,” said U.S. Attorney Jane J. Boyle. The investigation involved 137 federal agents and law-enforcement personnel from 14 local jurisdictions. (For a list of defendants, visit www.usdoj.gov/usao/txn. Click on “Press Releases,” then on the Feb. 5 release, “Operation Roll Over.”)

Last September, after authorities uncovered a $32 million power wheelchair billing scheme in Houston, CMS and OIG issued a 10-point initiative aimed at curbing fraud and abuse of the Medicare power wheelchair benefit. Among its points, “Operation Wheeler Dealer” required providers in Harris County, Texas (where Houston is located), to attend mandatory training on wheelchair coverage and medical review policies. The plan also required payment for motorized wheelchairs in Harris County to be “personally and individually approved” by CMS staff on a special task force.

The Senate Finance Committee is presently investigating companies that may be taking advantage of federal health care programs to increase sales and profits of scooters and wheelchairs, and news of the second Texas scheme sparked the possibility of congressional hearings on the matter.

“It appears that Medicare payments for power wheelchairs and scooters are so exorbitant that criminals have been seeking easy profits,” Finance Committee Chairman Sen. Charles Grassley, R-Iowa, wrote in a February letter to David Walker, comptroller general of the General Accounting Office. In anticipation of a hearing, Grassley asked the GAO to brief the Finance Committee staff on the issue.

For breaking news, go to www.homecaremonday.com, the electronic news service of the home medical equipment industry.