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Home Health & Hospice Week

Fraud & Abuse:

Suppliers Vent About Wheeler Dealer, Coverage

Published on Thu Mar 11, 2004

CMS mum on possible remedies.

Feelings were running high at a March 3 special listening session on Operation Wheeler Dealer, as CMS officials got an earful from suppliers on exactly what's wrong with the OWD changes.

"This policy is pushing a lot of small businesses out of business," fumed Donald Needham, owner of Indian Trail, NC-based Knowledge Concepts Inc., in the forum. Needham was referring to the so-called "clarification" of wheelchair coverage policy issued by the durable medical equipment regional carriers in December (see Eli's HCW, Vol. XIII, No. 3, p. 19).

"If we continue to go on like this, we'll be out of business," lamented Laura Mitchell, owner of Carol Stream, IL-based Chicagoland Accessibility. Mitchell was just one of the many suppliers who complained of wheelchair claims being held up in medical review since Operation Wheeler Dealer's launch last September.

Suppliers, beneficiary advocates, clinicians and others were furious with the Centers for Medicare & Medicaid Services and especially the DMERCs' implementation of the change to coverage policy. Here were some of their chief beefs:

  • No action from CMS. Highest on providers' list of complaints was the fact that CMS and the DMERCs have implemented the policy, but now claim that they haven't had enough time to make any further decisions on it or even talk about possible changes.

    After repeatedly calling CMS to set up a meeting on the policy change, the ITEM Coalition heard nothing, complained Peter Thomas. "And yet the machinery continues on down the line and this rule becomes more and more entrenched every day that goes by," Thomas blasted.

    "It's been three months since this policy has come out, and every day it goes on," agreed Don Clayback of The Med Group. "It's making a bad situation worse."

    Numerous providers implored CMS to move from the discussion phase to the action phase quickly. CMS reiterated that it wouldn't answer ay questions or set timelines in the forum. But an official did say "These forums are not just here to let you vent. They're not just here to act like we care, we do. We want to hear this input and it is valuable."

  • Providers punished. It was CMS that failed to catch the blatant fraud taking place in Harris County, TX and elsewhere, but it's law-abiding wheelchair suppliers who are paying the price, a number of supplier said. "This is a knee-jerk reaction to someone not paying attention ... they fell asleep at the switch," one participant commented.

  • Mom-and-pops. In a March 1 Associated Press article, a CMS official said it is big-business wheelchair companies trying to preserve their profits who are raising a stink about the wheelchair policy changes, not mom-and-pop organizations.

    Numerous callers and in-person attendees identified themselves as small mom-and-pop organizations hit hard by the changes. Typical mom-and-pops must rely on their trade associations to carry their message for them because they are too busy working to contact CMS and lawmakers, insisted Meir Raskis with Advanced Medical Concepts, a Baltimore-area supplier.

    A representative of Pride Mobility Products asked to pass on letters from mom-and-pops, and the CMS official assured he already was hearing from them in large numbers after the article.

  • Clinical basis. Clinicians ranging from physicians to therapists, researchers and beneficiary advocates attacked the new policy change's lack of clinical basis.

  • Cost shifting. The policy will increase Medicare costs by putting patients into long-term care institutions and by increasing falls and other injuries caused by manual wheelchair use, which will require costly hospital care, opponents said.

  • Beneficiaries. While suppliers are in danger of losing their business, it is beneficiaries whose quality of life is severely impacted by the coverage restriction, multiple participants emphasized. Many beneficiaries who "desperately need" mobility equipment can't access it under the new policy, Mitchell said.

    And even those who are covered face long waits for the equipment. Scott Scobey of Beaufort, SC-based Low Country Mobility says equipment they used to be able to deliver in 30 days now takes more like 120 days. 'If you're talking about somebody with ALS or a spinal cord injury, that's an eternity," Scobey told CMS.

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