Dear Acting CMS Administrator Smith:

Saturday, January 31, 2004

Editor, HME News

Your agency is today engaged in a crackdown on the wheelchair industry that defies any reasonable person’s sense of priority. While we don’t dispute the need to redress the egregious exploitation of the K0011 power wheelchair code in Harris County, Texas, CMS has embarked on a path that has seemingly ignored its own responsibility for the Houston debacle.

Where was the oversight? Who was asleep at the wheel in Region C? Why did the systems and people that monitor utilization of DME fail to hear the sucking sound of 31,000 power chairs migrating down to a single county in Texas.

These questions have been posed in this space before, but the answers, from CMS and DMERC officials, fail to persuade, fail to satisfy and fail to maintain the public’s faith that CMS is responsibly administering the precious Medicare resource.

Expenditures for power wheelchairs are not, despite former Administrator Tom Scully’s contention, a drop in the bucket. They represent more than $1 billion of a program that spent $267 billion in 2002.

Officials all the way up to Scully have blamed the failure to detect the Harris County fiasco on a lack of resources dedicated to administration. That answer, which keeps getting kicked around when one asks why the wheeler dealers had their way with the frailest, elderly residents of Harris County, fails to satisfy. In other words, you’ve got to do better.

If the wheeler dealers in Houston have prompted CMS to tighten coverage guidelines for the K0011 and ramped up the demand for an OIG report on K0011 reimbursement, isn’t it right and proper that CMS should take a good, hard look inside its own house?

You’ve rolled out a 10-point plan to stop the wheeler dealers. How about a five-point plan to implement some systems that will never again let 31,000 fraudulent claims for power wheelchairs parade past the people who are supposed to be watching out for fraudulent traffic?

Palmetto GBA, which administers the Region C DMERC, values its DMEPOS contract. Why else would Palmetto have renewed the contract every year since 1992?

Palmetto also runs the National Supplier Clearinghouse, which issued supplier numbers to every wheeler dealer, and the SADMERC, which tracks the claims data for all four DMERCs. If this organization is not held to account for letting those scam artists have their way with the resource they’re charged to protect, should they be held to account for anything?

You have to make some moves in public, Mr. Smith. The wheelchair industry, and Medicare beneficiaries, need to know that when you foul up, you’re also prepared to take your lumps.