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.   No matter how careful and compliant you are, "you won't keep the scrutiny away," warns one DME attorney.   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 [...]