Home Health & Hospice Week

Waiving copays, furnishing free equipment are red flags. 

You may not be able to avoid close scrutiny of your power wheelchair claims under Operation Wheeler Dealer, but you can take steps to reduce your exposure to rejected claims and even fraud charges.

The Centers for Medicare & Medicaid Services and the HHS Office of Inspector General launched the fraud-fighting initiative focusing on power wheelchairs and scooters earlier this month (see pdf of Eli's HCW, Vol. XII, No. 32, p. 251). The feds already are charging suppliers and others in power wheelchair schemes (see related story, "Enforcement").

As part of Operation Wheeler Dealer, carriers and other authorities will be going over power wheelchair claims with a fine-tooth comb. No matter how careful and compliant you are, "you won't keep the scrutiny away," warns attorney Gabe Imperato with Broad and Cassel in Ft. Lauderdale, FL.

But you can avoid getting caught in the crossfire by taking pains with your documentation for power wheelchairs, advises attorney Steve Azia with Washington, DC-based Eastwood & Azia. Good documentation can limit your liability to both reduced reimbursement and fraud and abuse allegations.

Your documentation should make clear why a power wheelchair, rather than a less expensive alternative, is appropriate and necessary for the patient, Imperato counsels. Extra documentation from the patient's physician, in addition to the certificate of medical necessity, will help, says Azia, who is counsel to the Power Mobility Coalition.

Once CMS clarifies its new medical review policies for power wheelchairs, as it pledges in its 10-point plan for Operation Wheeler Dealer, suppliers hope to have a better idea of exactly what documentation is needed to ensure payment for a power wheelchair, notes attorney Robert Falk with Powell Goldstein Frazer & Murphy in Washington, DC. Right now suppliers can cram their files full of documentation ranging from physician progress notes to videos of the patient, and nothing is guaranteed to prove the patient needs the device, Falk notes.

At the Sept. 11 Open Door Forum on the new initiative, attorney Cara Bachenheimer, representing Invacare Corp., emphasized that wheelchair dealers need clear guidance and specifics in the new policies so they can document accordingly. CMS should set out which consumer conditions qualify for which wheelchair products, she said.

In addition to strengthening documentation, experts say suppliers should avoid these four pitfalls when furnishing power mobility products.

1. Don't unduly solicit sales. Furnishing inappropriate incentives to either physicians or patients in the sale process is a major no-no.

2. Don't furnish free equipment or waive copayments. Telling patients that a wheelchair or other equipment will be free to them, with no qualifications, is a huge red flag under the feds' fraud-fighting program.

3. Don't send patients to physicians to be certified for a wheelchair. The feds have uncovered cases where one physician signed 25,000 CMNs for wheelchairs, and they aren't happy about it. Patients should choose their physician, not you.

4. Don't induce or pressure a patient's existing physician to sign a CMN. Draw the line between educating the physician and exerting overt influence. But suppliers tend to have the opposite problem, Falk says - physicians who want to certify the patient when she appears not to be eligible for the equipment.

"Often in those cases, all you can do is ask for more documentation from the physician," Azia says. "The doctor is captain of the ship."

Falk warns that if a supplier knowingly furnishes equipment that is medically unnecessary, "that rises to the level of a false claim."

Tip: Make your toughened-up documentation and rules part of your internal compliance plan, Azia recommends. Then, be sure to follow up and track whether employees are sticking to the policies. "Make sure they're following the rules by letting them know they'll be monitored," he says.