Wheelchair Fraud by Steven Mussey MD

Wheelchairscam-2

A couple of years ago, when a frail elderly patient needed a wheelchair or walker, I wrote the order and it somehow appeared.

Then, providers of “durable medical equipment” discovered this easy system was a great way to commit massive Medicare fraud.

So, the government, in its infinite wisdom, took action: It chose to annihilate the ordering doctor who never profited from the scams. Doctors are now clobbered with massive documentation requirements every time there is a request for even the most minor piece of “durable medical equipment.”

Now, when a family requests a wheelchair, I groan. More often than not, the request will actually take a separate “face to face” visit with incredible levels of documentation to state pages of obvious facts in perfect legal language, written by my own hand (meaning: Nobody can do it for me).

These encounters are ridiculous inconveniences for the family transporting the frail patient and disastrous to the day’s schedule.

So, how bad is this fraud problem? Is this requirement for absurd levels of documentation by the ordering doctor fixing the problem?

The answer is: The fraud is really bad and, no, it is not being fixed.

Here is an example:

Several years ago, I needed to buy a wheelchair for our office. I went online to Staples.com (yes…Staples…) and bought a regular sized, full featured wheelchair for $170. It’s been great.

When patients arrive in their own wheelchairs, I marvel at how our $170 Staples wheelchair is holding up compared to the devices patients received through Medicare. I had no idea how much Medicare paid, but I always suspected Medicare had been scammed.

I had no idea!

Several times over the past month, an elderly patient has been deemed to require a wheelchair.

The medical supply company says “Medicare requires a face to face visit” and “we are sending a representative with the patient to make sure you document appropriately.”

A sales person is coming in with the patient? Now, I am getting uncomfortable! Sales people tend to only take time off when the payoff warrants the visit. How could a $170 wheelchair warrant a salesperson escort to the office?

Answer: It makes sense when the payoff is a lot more than $170!

Yes, I understand one reason: The documentation requirements by the doctor are horrendous and even minor omissions or misstatements will prevent reimbursement for the device.

On the other hand, I don’t like sales people getting involved when documentation errors can put me in jail for Medicare fraud!

Last week, a doctor’s mother needed a wheelchair. It would be a regular wheelchair with a few minor adjustments. The sales person was going to accompany her to the office.

“No thanks! Just send me written reminders of what you need.”

At some point, the patient’s daughter asked: “How much will this wheelchair cost Medicare?”

The answer: $3,500.00!

Really?!?!?

Pause for a moment and ponder this mark-up.

Are the few minor (and likely unnecessary) adjustments cranking up the price? What’s the story here?

It’s not clear.

In fact, this is a wheelchair which is virtually identical to the $170 wheelchair I bought at Staples. It is also currently available on Amazon Prime, with 48 hour shipping for….under $200.

Everyone’s response: “THIS IS INSANE!!!!!”

The sales representatives responded: “Don’t worry! It’s covered by Medicare!”

I suppose the proper response is: “Oh! Then, it’s okay. Let’s get the gold plated model….”

The elderly patient was so horrified; she turned down the Medicare device. Instead, she is using a standard sized $180 wheelchair purchased recently on Amazon by a friend who no longer needs it.

She is very happy with her decision.

Younger generations owe this elderly responsible citizen a debt of gratitude.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  11 comments for “Wheelchair Fraud by Steven Mussey MD

  1. April 29, 2015 at 9:01 am

    As a former military officer who once had some purchasing responsibilities. I can tell you where the blame lies. With your elected officials. This is simply a scheme to move your tax dollars to their supporters, er… approved suppliers, who send it back to them. The reason we have all this expensive crap (mine was a $3000.00 fax machine I could get for $200.00 at the PX), is politics. Bet they never, no matter what, investigate that. Just bury the people who could figure it out in paper work.

  2. Leslie
    April 27, 2015 at 5:08 pm

    After 30 years of beds nursing, I went into another type of nursing. I review preauth and claims reconsideration denials, for DME for a major Healthcare insurance company. Within weeks, I was writing letters to congress people, stating this outright fraud from the DME providers. The DME providers “assess” which specific product would serve the member best. One particular company, that was my main focus, is now out of business.
    Some of this health care mess, from excessive dollar usage, could be resolved by taking the real nurses and real doctors, those that still take care of patients.

  3. April 27, 2015 at 2:27 pm

    This is what happens when the consumer (Patient) is disconnected from the paying. Singapore posts pricing for health care. The consumer can look up charges and then make choices; Value=Quality/Price. The American consumer has no way of knowing the numerator or denominator to determine value. The word “price” has been replaced by the word “cost’ as if the calamity we are experiencing is a “fait accompli.” When gas “prices” were surging, Congress was in a uproar. At the same time, health care costs were off the charts, not a peep. Singapore has a market system and uses 4% of their GDP for health care. Socialized Europe is at 8%. With crony capitalism we are between 16-18% depending on who you read. We have people in Congress that actually believe there is a “free market” in health care in the US. Adam Smith wrote long ago about the problem we are experiencing: “People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices. It is impossible indeed to prevent such meetings, by any law which either could be executed, or would be consistent with liberty or justice. But though the law cannot hinder people of the same trade from sometimes assembling together, it ought to do nothing to facilitate such assemblies; much less to render them necessary.” In the United States, we have gone far beyond “facilitating” the meetings.

    • Pat
      April 27, 2015 at 6:04 pm

      Nailed it.

  4. Pat
    April 27, 2015 at 1:15 pm

    I did some writing along these lines a decade ago, when Sen. Grassley (Io-R) was complaining about spending $1.2 billion in 2003 for “power mobility aids.” We were expected to see a sharp rise in the clinically obese, up to 74 million by 2006, and a corresponding increase in the production of, yes, bariatric scooters to accommodate those over 250 lb. On average the costs for these were $2,000, for which Medicare was paying $5,000.

    And the doctor was paid, for all of the accompanying time and forms which had to be in within 45 days … $21.60.

  5. Ann Deluty
    April 27, 2015 at 12:54 pm

    Our Senior Center usually has all kinds of wheelchairs, shower chairs, walkers, canes crutches etc. for loan or giving. FREE. There are even blood pressure devices sometimes. FREE. But of course they have already been paid for many times over by Medicare.

  6. Private doc
    April 27, 2015 at 7:11 am

    Part of it is the same reason a Tylenol costs 100 bucks in the hospitals. Gubment requirements. For the Tylenol the order must be written by the doctor a pharmacist must dispense the medicine a paid tech or expensive tube system must deliver it and a nurse must administer it. All of that overhead for an OTC Tylenol. I’m sure it’s similar for the device company. Probably doesn’t explain all the excess cost but I bet excess requirements are most of it.

  7. April 27, 2015 at 6:06 am

    Reading this makes my blood boil. Have just reached Medicare age and am fortunately completely healthy. But if and when the time comes that I need some sort of device like this, I will check into the prices and purchase my own if possible.

  8. April 27, 2015 at 5:36 am

    Welcome to the wonderful world of PM&R! 😉 And guess what the U.S. Navy pays for mechanical parts that can be found at ACE Hardware? And yet so many are lobbying for a larger role for govt in healthcare. Argh!

    • JP
      April 27, 2015 at 9:54 am

      I suppose the U.S. Navy E police may be more reasonable than Medicare’s. Both are U.S. federal health programs. At least these patients can get the wheelchairs the need. Many cannot.

      • Cliff
        April 27, 2015 at 8:27 pm

        Great comment. The single payer advocates never bring up the US Defense Department as a great example. If they can get a hammer up to 300 dollars, imagine what can happen with an MRI!

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