HME providers react to Houston Medicare scams

Tuesday, September 30, 2003

HOUSTON - HME providers in the Houston area are drawing a line in the sand as they attempt to distinguish themselves from a series of fly-by-night power mobility dealers who have come under investigation by the FBI and other federal agencies.

Some area dealers came under scrutiny for recruiting seniors from across the state and into Louisiana and bringing them by the bus load to Houston to get fitted for expensive, Medicare-covered wheelchairs - many of them unneeded by the recipient.

“They were filling out 60-something claims a day. Why wouldn’t that throw up a red flag,” said Larry Rice, general manager of The Wheelchair Shop in Houston.

Although the FBI’s investigations have focused on Houston, they are resonating all over the country as rehab dealers feel the heat of increased federal scrutiny. The Houston scams also were not lost on the Power Mobility Coalition, which is trying to distance itself and its members from the alleged scams by reaffirming the industry’s quality standards in weeding out fraud and abuse.

“It’s always a black eye when someone is going to abuse the system because, quite frankly, it tarnishes those who are playing by the rules,” said Steve Azia, counsel for PMC.

Providers are worried the scam will shed a negative light on the industry as a whole and ignore the fact that there are many honest dealers in the area.

Rice said newspaper coverage of the investigations has cast a shadow on the images of dealers who “play by the rules.”

“I think the focus is too much in the negative, and now everyone’s going to sit there and go ‘all wheelchair vendors are bad now,’” said Rice. “I’m kind of afraid of that. That’s what I’m looking at a as backlash.”

Rice said that most providers, like himself, found the actions of the providers-in-question to be unethical and that many providers and manufactures refused to do business with them for this reason. One manufacturer even started its own investigation into the practices of these groups and refused to do business with them.

“I was proud of the way that manufacturer was handling it,” said Rice.

Other providers, angry about the situation, took a proactive approach to help end the problem. Kevin Tunstall, manager of Healthtec Medical in Houston, reported a suspected fraud case to the FBI last month when he met a patient who had been given a power wheelchair that was not fitted to meet the patient’s needs.

“The way I understand Medicare fraud is that committing fraud against the government is a felony,” said Tunstall. “And in this state, failure to report a felony is a felony. If I don’t report it, I am breaking the law.”

Azia said he hopes actions like Tunstall’s will prove to the government that the industry is serious about weeding out those who abuse the system.

PMC also applauded the efforts of law enforcement agencies in addressing the problem, which, so far, has led to the indictment of one Houston doctor on 37 counts of conspiracy and health care fraud. Two operators of a local medical group also pleaded guilty to health care fraud in a related case.

The U.S. Attorney’s office could not comment on any ongoing investigations.

Rice said the problem seems to have waned and that he is not receiving as many calls from the new dealers. However, both Rice and Tunstall are not optimistic that the problem has disappeared.

“The industry is always talking about how we need to police ourselves. Then do it,” said Tunstall.

“This is and industry I love, and I don’t want to see it get any more back eyes,” said Rice