Maximum Comfort vs. CMS

Sunday, November 30, 2008

REDDING, Calif.--It’s hard to believe, President Tom Lambert says, but it has been nearly 10 years since Maximum Comfort found itself embroiled in a battle with CMS over power wheelchair documentation.

In 1998-99, the Redding, Calif.-based provider delivered the power wheelchairs that would lead CMS, in 2000, to declare overpayment. Ever since, the two parties have gone back and forth in various courts about whether CMS had the right to ask Maximum Comfort to repay $600,000 for not supplying additional documentation beyond certificates of medical necessity (CMNs).

“For the first few years, it was a nightmare,” Lambert said. “But after that-before you asked about it just now, I hadn’t thought about it in months. I had to stop and think, ‘Oh yeah, that’s still out there somewhere.’”

Most recently, the U.S. Supreme Court sided with CMS this fall. Maximum Comfort plans to go back to federal court.

Maximum Comfort’s case, when it first hit the courts, had the potential to turn CMS’s world upside down. If the courts agreed with Maximum Comfort-and some have, over the years-other targeted providers could file suits based on precedence.

But providers no longer use CMNs for power wheelchairs; CMNs were replaced with physician prescriptions and supporting documentation in November 2005.

So what keeps Lambert going?

“It’s the Safe Harbor provision,” he said. “If they tell you to do one thing and then later on, they tell you to do something else, you should have some protection, because you didn’t have proper notification of what they wanted you to do.”

One thing Lambert has learned over the past 10 years: “Don’t deal with Medicare.”
Lambert now focuses on Medi-Cal, the Medicaid program for California.