Fraud hurts people with disabilities

Friday, September 26, 2014

On Aug. 16, 2014, the Washington Post published an article entitled “A Medicare Scam That Just Kept Rolling” regarding fraudulent Medicare power wheelchair payments that unfairly perpetuates a black cloud over dedicated and accredited Medicare durable medical equipment (DME) providers. More importantly, it makes it harder for people with real disabilities and chronic medical conditions to get the mobility equipment they need. 

This is especially troubling for Medicare beneficiaries with significant disabilities who rely on “complex rehab” power wheelchairs and seating systems from qualified Complex Rehab Technology (CRT) providers.

The fact that CMS did not have the right controls in place and allowed scammers to steal from the system in the 1990-2000s is an unfortunate story that was well documented years ago. The fraudulent and abusive billings and payments should not have been allowed to happen. The problems were caused by a very small group who were out to abuse and defraud the Medicare program. They were bad apples and it was (and is) CMS’s job to keep them out. Thankfully significant changes have been put in place by CMS since 2006 to make it much harder for criminals to defraud the program. 

NCART members whole-heartedly agree fraud and abuse needs to be identified and stopped. We regularly express our desire to CMS to collaborate on solutions that protect the Medicare Trust Fund. The CRT/DME industry has long promoted and supported better controls and higher provider standards to protect the Medicare program and its beneficiaries. These improvements have included requiring: independent provider accreditation, beneficiary visits with the prescribing physician, and submission of supporting medical necessity documentation for approval prior to billing. Our shared objective is to make sure only medically necessary quality equipment is provided so that Medicare dollars are protected. 

Medicare beneficiaries with significant disabilities rely on complex rehab power wheelchairs to manage their medical needs and to participate in basic activities of life. Medicare CRT providers strive to do the right thing and serve people who have true disabilities and need mobility and seating assistance as prescribed by their physicians. However, in making changes, a Medicare beneficiary’s access to medically necessary equipment must be protected from negative unintended consequences in the “safeguarding” process. 

Congressional legislation has been introduced to provide stronger safeguards and protect access for people with disabilities who require CRT. The “Ensuring Access to Quality Complex Rehabilitation Technology Act” (H.R. 942 and S. 948) includes improved standards and safeguards for complex rehab wheelchairs. The bill enjoys broad bipartisan support with 152 House members and 21 Senate members signed on and is supported by  50 national consumer and medical professional groups. This legislation will provide additional improvements and has broad CRT industry support.

NCART is committed to continuing to collaborate with CMS and other Medicare stakeholders to eliminate fraud and abuse, while at the same time protecting access to the critical equipment required by Medicare beneficiaries with significant disabilities and chronic medical conditions.  The most effective protection of the Medicare program will come from ongoing collaboration. This is the strategy that should be more fully embraced and the message that should be making the news.

—Don Clayback, executive director, NCART