Senior Caregiving Blog- Elder Care & Caregiving News & Tips – Caregiverlist.com

Great article! I reposted it on my Twitter account and on Amigo's Facebook page. I think it is so important to spread the word about Medicare fraud as it ultimately hurts the customer. We've had many Amigo owners that have been taken advantage of by other companies and are very upset and frustrated. We're also trying to spread the word and wrote this article including tips on how to find a reputable medical dealer to work with: http://www.myamigo.com/hc/hcinfo.aspx?ID=kgTIqrpy1rUA

Thanks! -Jennifer

I can't believe Congress spends so much time complaining that we can't afford to provide health care coverage for everyone yet allows billions to be spent on fraudulent Medicare claims and I also can't believe the payouts are so high to attract the fraud - I guess the lobbyists do run things in Washington!

It is not surprising the government pays out a lot for fraud, but $60B?!! Wow that caught my eye! I wonder how much is detected and actually recovered...? Another loop hole in our healthcare system that will hopefully draw attention sooner rather than later.

At The SCOOTER Store, we appreciate and welcome comments from organizations like yours as well as the general public. We hope to educate your readers about the facts related to the company and this important Medicare benefit. With that in mind, we have some clarifications to your statements.

Congressional law and Medicare regulations require a patient see their own treating physician for consideration for a power wheelchair. Their medical evaluation is the primary factor when considering whether medical need exists. Prior to the office visit, the patient is subject to our very through screening process. It is during this initial screening process (http://www.supportmobilitynow.com/marketing_leads_to_over_utilization/index.asp) that the company disallows 70% of those inquiring about power mobility from insurance consideration.

Those with medical conditions such as heart disease, lung disease, diabetes and MS (for example) are sent to their own treating physician for further evaluations. The physician will complete a comprehensive examination of the patient; not everyone will qualify. In fact, physicians generally rule out two out of every three patients they see.

Once a physician provides his prescription and complete medical records to The SCOOTER Store, a team of nurses with 520 years of clinical experience review the medical information to ensure medical necessity has been established by the beneficiary’s physician. We have over 70 Quality Review Standards in place. In the end, only one out of every 11 beneficiaries qualifies for insurance-covered power mobility. The SCOOTER Store has never employed physicians. The doctor-patient relationship is critical in the continuum of care and cost effective outcomes.

The SCOOTER Store has filled nearly 500,000 prescriptions in 18 years. The company has never been convicted of fraud. While we maintain that every prescription filled is within the rules that govern the Medicare program, we entered into a settlement agreement with the government and a fine was paid. As a result, we are a stronger company. We are committed to ensuring that seniors are fully educated about fraudulent and wasteful practices (http://www.supportmobilitynow.com/fraud_prevention_information.asp).

The company is uniquely positioned to manage costs and improve healthcare outcomes through its more than 70 stores nationwide. An economic study (http://www.supportmobilitynow.com/power_mobility_economic_study.asp) shows that we have helped the federal government save nearly $7 billion dollars in fewer hospitalization and emergency room visits due to falls and fall-related injuries.

Should you have any additional questions or comments, please feel free to contact me at 830-627-4444 or e-mail lygonzales@thescooterstore.com. Thank you.

Glad the Scooter Store commented on this - - but, the Federal government did file a lawsuit based on factual evidence that was obvious enough for an employee of the Scooter Store to receive the whistle blower award. Ouch! Glad the Scooter Store has cleaned up their act - however, I think their TV commercials are still a bit much as they certainly don't provide the information their PR person gives here - instead they say they'll give the scooter free if they can't get it approved by Medicare. Looks like the government also changed reimbursements because of their hanky panky so that also makes it more difficult to play games in this area. As a caregiver who has worked with seniors who needed a power wheelchair, I would still recommend going to a local medical supply company as you will probably need a couple visits to get the fitting of the chair just right and will probably get a higher quality chair than what the Scooter Store pushes.

Straight from the San Antonioa newspaper - the Scooter Store is more forthcoming of their erros than in the PR reps post above:
The Scooter Store has agreed to pay the federal government $4 million and to forgo about $13 million in Medicare payments to settle charges that the New Braunfels company made false Medicare claims, according to the Department of Justice.
The DOJ claims that the Scooter Store, which operates and advertises nationwide, received $5,000 to $7,000 for every power chair they sold. In many of those cases, the senior citizen wanted a less expensive scooter to improve their mobility at a cost of $1,500 to $2,000.

"This settlement is part of our ongoing commitment to fighting abuse of Medicare's durable medical equipment benefit," Assistant Attorney General Peter D. Keisler said in a written statement.

The firm's top executive maintains the government's claims are untrue, but that it was worth settling the suit so the company could start getting paid by Medicare again. The company sells and services power wheelchairs and scooters to assist mostly senior citizens with mobility.

The DOJ "can outspend us and outlast us," company founder Doug Harrison said. "We just need to get back to a healthy relationship with Medicare."

When the company sued Medicare 3½ years ago for nonpayment of claims, Medicare employees were forbidden from talking to Scooter Store employees and the FBI launched an investigation of the company, Harrison said. The government filed its own lawsuit against the company in 2005.

The settlement includes $1.5 million from the company and $500,000 from Harrison's personal fortune. The other $2 million is repayment from a billing error that was identified by the Scooter Store and was being repaid before the government told them to hold off until the litigation was settled, Harrison said.

Harrison also will not take dividends on company shares for a year, according to the settlement.

The payments settle several lawsuits, including a whistleblower suit from a former Scooter Store employee. The whistleblower will receive $3.2 million from the government.

The Federal Bureau of Investigation conducted a lengthy inquiry into the Scooter Store, which had several lawsuits against Medicare for about $43 million in billings. The government said had it paid those claims, it would have been for only about $13 million under the current reimbursement formula.

The Scooter Store will be able to do business with Medicare going forward, but the DOJ said the company will operate for five years under a corporate integrity agreement overseen by the Department of Health and Human Services Officer of the Inspector General.

"The Scooter Store engaged in a multimedia advertising campaign to entice beneficiaries to obtain power scooters paid for by Medicare, Medicaid, and other insurers," according to the DOJ. "Instead of the 'zippy' power scooters that were advertised, the Scooter Store sold the beneficiaries expensive power wheelchairs that they did not want, need, and/or could not use."

Harrison said each of the prescriptions for the power chairs came from doctors that wouldn't have ordered scooters for their patients because the scooters aren't right for medically fragile seniors who run the risk of tipping over in a three-wheeled scooter.

And from Forbes Reporting -the Scooter Store actually caused a huge increase in Medicare costs for inappropriate wheelchairs:

Government spending on power wheelchairs climbed 450% between 1999 and 2003, to $1.2 billion. A report released last year by Health & Human Services' inspector general found that only 13% of those it surveyed who got the most popular wheelchair met the Medicare coverage requirements. This is what happens when someone is spending other people's money.

The four contractors that process Medicare's wheelchair claims--Palmetto GBA, Cigna HealthCare, AdminaStar Federal and HealthNow New York--saw a spurt in spending as early as 1997, but the office that runs Medicare and Medicaid did not lead a coordinated response until 2003, says the Government Accountability Office.

In one egregious case last year the U.S. Attorney in Houston charged two physicians, Charles Skripka Jr. and Jayshree Patel, for conspiring to defraud Medicare of $40 million between February 2002 and June 2003. The duo allegedly approved wheelchairs for up to 50 Medicare beneficiaries per day, in return for kickbacks from the suppliers. The doctors have pleaded not guilty; the owner of their clinic, Lewis Gottlieb, has put in a guilty plea and is helping the government.

The feds in April sued the Scooter Store of New Braunfels, Tex., which billed Medicare for $400 million or so since 1997. In ads, the Scooter Store suggested to old folks that the government would pay for scooters. But, the government alleges, when customers called the company to inquire about reimbursement, the Scooter Store pushed motorized wheelchairs on them, with the result that Medicare ended up paying for expensive and unnecessary equipment. The government is supposed to pay for a motor-driven chair only if the patient would be confined to bed without one. The Scooter Store says it has done nothing wrong and that the government is trying to get out of repaying legitimate claims.