CMS wronged Maximum Comfort

Saturday, April 30, 2005

REDDING, Calif. -- A federal judge in March issued a final ruling that CMS had been wrong to demand that Tom Lambert repay Medicare $600,000 for not supplying documentation beyond the CMN to prove medical necessity for power wheelchair claims.
In his ruling, the U.S. District Court Judge Lawrence Karlton wrote: "any medical necessity information required from medical equipment suppliers may be submitted to the Secretary only by way of a Certificate of Medical Necessity, and not by other means, such as obtaining Medicare beneficiaries' medical records."
Initially, CMS informed the owner of Maximum Comfort that he must repay Medicare about $1 million, but eventually dropped the amount to $600,000. After winning a preliminary ruling last summer, Lambert asked the judge to order CMS to pay him $460,000 in principal and interest for money already recouped. In his final ruling, however, Karlton wrote that he does have the power to do that and left it up to the U.S. Department of Health and Human Services to determine the repayment amount.
"I don't owe them anything, but how much they owe me is up to the secretary -- that's ludicrous," Lambert said. "You sue someone, they lose in court, and then they decide how much they owe you. It's bizarre."
While the Maximum Comfort ruling applies only to the Eastern District of California, providers in other parts of the United States have used the ruling to argue similar cases against CMS, including the Scooter Store. In all, Lambert said, about 25 providers have contacted him and requested information outlining how he fought and won the case.
"We didn't get a million dollar reward, but it is another step in the right direction," Lambert said. "It's another little battle that has been won, but this issue isn't going away this year or next."