Wheelchair scams exploit Medicare fraud risks, but what's next?

Fraud schemes involving power wheelchairs have exposed Medicare's fat and vulnerable underbelly, according to an article in The Washington Post.   

"Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and 'scooters' for 2.7 million people," The Post reported. "Today, the government cannot even guess at how much of that money was paid to scammers…When officials go back to try to figure out what the scammers stole, they get mired in an unholy bureaucratic mess."

Problems with motorized wheelchairs have been legion: Claims have paid for undelivered chairs. Suppliers billed for power wheelchairs but provided cheaper, low-end equipment. Criminals paid recruiters to trick, bribe or pressure beneficiaries into disclosing their Medicare identification numbers and then used them to bill for unnecessary or unwanted wheelchairs. Many of these sit unused in garages. Scammers paid kickbacks to crooked doctors to order motorized wheelchairs or certify their necessity for patients who didn't want or need them. And clever suppliers learned to stay under the government's investigative radar.

Medicare hasn't always been a prudent equipment buyer. The program used to pay for power wheelchairs based on manufacturers' suggested retail prices, according to The Post. This pay-through-the nose policy lined criminals' wallets for years, since suppliers can buy motorized wheelchairs for $900 each but have billed Medicare about $6,000 per item, as FierceHealthPayer:Anti-Fraud reported.

Another problem was how slowly authorities responded to motorized wheelchair overutilization. Despite spotting this claims trend as early as 1998, it wasn't until about five years ago that the federal government launched a competitive bidding program for durable medical equipment to cut costs. And Medicare's preauthorization demonstration for power mobility devices started in 2012.     

Meanwhile, power wheelchair benefits became an express ticket to wealth for criminals. Scammers who didn't finish high school collected more than $10 million in three months, The Post noted.

"If you play it right, you can make a lot of money quickly stealing from Medicare," James Quiggle of the Coalition Against Insurance Fraud told The Post. "You can walk into the United States with limited English skills, no knowledge of medicine and - if you hook up with the right people that know how to play the system like a Stradivarius - you can become an overnight millionaire." That's a perverse twist on the American dream.

I'm concerned that issues like power wheelchair fraud provoke yawns from a jaded public. Many people are desensitized to prodigal spending in Medicare. Did we miss our outrage cue? How many examples do we need that Medicare isn't a tight ship, and when do taxpayers start requiring more?   

For years, the Office of Inspector General has said Medicare is a fraud target due to its complexity and scope. For years, OIG audits of the Centers for Medicare & Medicaid Services have found oversight gaps. For years, we've grumbled about timely claims processing laws requiring insurers to pay claims first and ask questions later. Thirty years ago when I started working for a health plan, my boss said we needed to shift emphasis from retrospective to prospective review. We're still saying that. Sometimes it seems we're stuck in a fraud and abuse response loop without significant forward progress. That loop is an advantage for criminals.

"The whole thing," The Post said of Medicare, "is set up as a kind of honor system, built at the heart of a system so rich that it made it easy for people to be dishonorable." And that means Medicare's power wheelchair problems may happen again as scammers abuse different benefits in similar ways. Whether that sparks enough indignation to drive change is another question. - Jane (@HealthPayer)