The Scooter Store Sues HHS for Unpaid Claims

San Antonio

The Scooter Store has filed suit against the Department of Health and Human Services, seeking payment for hundreds of thousands of dollars worth of denied Medicare claims.

According to the suit, filed Jan. 25 in federal district court, Medicare failed to reimburse The Scooter Store for 101 power wheelchairs and scooters delivered to Medicare beneficiaries from 2000 to 2003. The New Braunfels, Texas-based company also charges HHS with violating the law by demanding documentation to prove a patient’s need for the equipment in addition to a physician-signed Certificate of Medical Necessity (CMN).

“The CMN is defined by Congress as a formal document to establish medical necessity,” said Stephen Azia, an attorney representing The Scooter Store. “If you’re a medical supplier, you have the right to rely on a document completed by the physician to establish medical necessity.”

In an effort to crack down on fraud, CMS has routinely requested additional records from providers to prove medical necessity.

In a similar case involving Redding, Calif.-based provider Maximum Comfort, a judge issued a preliminary ruling last year stating that a properly completed CMN was enough for supplier reimbursement.

“We felt the federal judge [in California] followed the law in that case, and that’s all we ask,” Azia said.