View this article online: https://www.claimsjournal.com/news/southcentral/2004/11/10/47589.htm
A reportedly sharply restrictive Medicare claim review process limited to the Houston area has denied reimbursement for power wheelchairs for hundreds of beneficiaries and forced a provider of those products to cease serving beneficiaries here as they had for more than a decade.
The SCOOTER Store announced Wednesday that it no longer can provide power wheelchairs and scooters to Houston-area Medicare beneficiaries on an assigned basis. When a Medicare supplier provides services on an assigned basis, the beneficiary only pays their co-pay and the supplier waits to get the other 80 percent directly from Medicare. Denied and unpaid claims for power wheelchairs here over the last year have reportedly cost the company more than $2.5 million.
The New Braunfels-based company said it has been reimbursed for only eight of more than 500 wheelchairs delivered to beneficiaries in Harris County this past year. Nationwide, the company said approximately 95 percent of claims it files on behalf of Medicare beneficiaries are approved.
As a result, the firm is closing its local distribution center and transferring those functions to its retail location on the Katy Freeway. Operations at the company’s Gulf Freeway store will be maintained.
“We deeply regret having to take this action,” said Mike Pfister, president of The SCOOTER Store, “but we were left with no choice.”
Pfister pointed out that The SCOOTER Store had continued to serve Harris County despite restrictive guidelines imposed specifically in this market in response to widespread fraud and abuse in 2003. At the urging of the power mobility industry, and following media reports of rampant fraud, the Centers for Medicare and Medicaid Services (CMS) in September of last year initiated Operation Wheeler Dealer.
As part of that operation, CMS transferred processing of all Harris County area claims to its Dallas regional office and reportedly imposed drastically more restrictive interpretations of coverage guidelines than anywhere else in the country.
“For more than a year, we have continued to help elderly residents of Harris County who meet all Medicare eligibility criteria for power mobility to maintain their freedom and independence,” said Pfister. “While other providers left the market, we assisted more than 500 Medicare beneficiaries in and around Harris County receive the medically necessary equipment prescribed by their personal physicians. We provided this equipment up front to address our customers’ needs and then filed for reimbursement from Medicare,” he said, noting that few seniors have the resources to pay for such equipment in advance.
“But as of November 1, CMS had reimbursed The SCOOTER Store for only eight claims for Houston area residents since announcement of Operation Wheeler Dealer.”
Pfister said that the near blanket unpaid claim rate of 98.4 percent in Harris County is all the more frustrating when claims filed in other regions on behalf of its customers with virtually identical medical conditions and documentation are approved at a 95 percent rate.
“We applaud and support CMS’ efforts to combat fraud,” said Pfister, pointing out that The SCOOTER Store and others in the industry reported suspicious irregularities in Houston to Medicare authorities almost two years ago, long before the agency took any action. “But the current crisis is not about fraud. The real injustice today is the geographical discrimination against hundreds of qualifying beneficiaries who are being penalized only because they live near Houston.”
Pfister said The SCOOTER Store is thought to have been one of the few remaining providers that had continued to file Medicare claims for power wheelchairs in Harris County. Several other providers have gone out of business or stopped offering power mobility equipment. He stressed that none of The SCOOTER Store’s customers would lose their power wheelchairs because of the company’s commitment that all customers can keep their equipment even if Medicare denies their claim.
In announcing it no longer can provide power wheelchairs based on potential reimbursement, Pfister said The SCOOTER Store will continue to offer power mobility equipment to the disabled through private insurance, cash or credit-financed sales.
It also will honor its commitment to provide maintenance and repair service to all its customers in Harris County.