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:
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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.
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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.
