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Regulations:

5 Weapons Against Wheelchair Fraud Could Save Your Business

Published on Thu Mar 18, 2004

Suppliers brainstorm for Operation Wheeler Dealer relief. 

If beleaguered wheelchair suppliers get their way, a 100 percent preapproval process could be the cure for Operation Wheeler Dealer ills.

Measures stemming from the feds' crackdown on Medicare wheelchair fraud are killing legitimate suppliers, warned numerous participants in the Centers for Medicare & Medicaid Services special listening session on the matter March 3 (see Eli's HCW, Vol. XIII, No. 10). New restrictions on coverage policy and months of wheelchair claims holdups are cutting suppliers off at the knees, and preventing eligible beneficiaries from receiving their chairs on time or altogether, suppliers said.

"If it's a legitimate, valid claim, tell us up front," one supplier told CMS.

Suppliers want CMS and the durable medical equipment regional carriers to rescind the so-called "clarification" to wheelchair coverage policy issued in December. The policy is poorly structured and has no impact on wheelchair fraud and abuse, just on legit providers, attorney Cara Bachenheimer with Elyria, OH-based Invacare Corp. noted in the forum that attracted nearly 400 participants.

Beneficiary advocate Henry Claypool also called for the policy's rescindment. The change is "penny wise and pound foolish" as it pushes costs from the DME benefit to institutional, rehab and physician services after injuries and falls without proper equipment, Claypool argued.

As an alternative to the coverage change and other harsh Wheeler Dealer policies, suppliers offered these suggestions to prevent wheelchair fraud and abuse:

  • Pre-approval. A number of suppliers called for a 100 percent pre-approval process for wheelchairs. "If it's a legitimate, valid claim, tell us up front" before the dealer purchases and delivers the equipment, said a WorldMed representative.

    Make any prior authorizations final, urged Scott Scobey of Beaufort SC-based Low Country Mobility. Suppliers should be able to submit their paperwork, and Medicare can decide whether "to cover it or not," Scobey told CMS.

  • Coding. Having one catch-all HCPCS code for power wheelchairs, K0011, is a mistake, suppliers warned. There are thousands of K0011 wheelchairs, and a coding change should differentiate the "plain sit-and-go's" from more sophisticated and costly rehab chairs, said Jay Turner with Holland Medical.

    The time DMERCs spend scrutinizing "consumer" chairs could be much less than for rehab chairs, Scobey said.

    Tying codes for certain power wheelchairs to ICD-9 diagnosis codes that allow patients to qualify for the chairs would be helpful, suggested Laura Mitchell, owner of Carol Stream, IL-based Chicagoland Accessibility.

  • Credentialing and accreditation. CMS can keep out the fly-by-night operators by requiring accreditation of suppliers and/or professional credentials for wheelchair dealers' supervisors and management, offered one Baltimore-area supplier.

  • Surety bond. A surety bond requirement is already on the books, and if CMS enforced it, criminals might steer clear of the program. But expensive items such as bonds and accreditation will make it harder for honest small providers to participate in Medicare, the Baltimore supplier said.

  • Educate beneficiaries. Letting beneficiaries know what to expect -- and what to watch out for -- can be the quickest way to identify fraud, said one Senior Medicare Patrol contractor representative. "There's confusion at the provider level" about wheelchair eligibility, but "there's even more confusion at the consumer level," the rep said.

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