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!
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.Tweet