Scooter Store sues Medicare over disputed PWC claims

Sunday, February 6, 2005

February 7, 2005

SAN ANTONIO - The Scooter Store, the country's largest supplier of power mobility products, filed suit in federal district court in San Antonio on Jan. 25, 2005 seeking payment from Medicare for 101 power wheelchairs and scooters delivered to Medicare beneficiaries at the request of their treating physicians in 2000 through 2003. 
The Scooter Store contends that the Department of Health and Human Services ("HHS") is violating the law and its own rules.
Prior to submitting any Medicare claim and prior to receiving any Medicare reimbursement, The Scooter Store received a CMN from the patient's treating physician. The treating physician completed and signed the CMN and certified the accuracy of the information subject to penalty of law, The Scooter Store stated in a release.
“Every time a wheelchair or scooter was provided to somebody it was because that person's doctor said they needed it, and because the doctor completed the exact paperwork that the law and the rules of the department required them to complete," according to Valerie Eastwood, an attorney representing The Scooter Store.  "In spite of its compliance with HHS rules and the requirements of the law, The Scooter Store is being denied reimbursement for mobility equipment delivered to the patients of doctors who have prescribed it," Eastwood said.

HHS has demanded that The Scooter Store and other providers routinely and regularly supply them with volumes of information in addition to the CMN, in violation of HHS's own policies and the laws governing the Medicare program, The Scooter Store contends.
The CMN was defined by Congress, developed by CMN, and approved by the Office of Management and Budget as the Medicare document of record designed to establish medical necessity.  The Scooter Store contends that the routine and regular demand for additional paperwork from suppliers is inconsistent with the law and that the unacceptable delay in payment for wheelchairs and scooters after they are delivered makes it more costly and difficult to supply equipment to patients who need it. 
“Through a period of years, the government developed the certificate of medical necessity requirement in order to avoid confusion and bring integrity to the Medicare program, but the department's present approach, which violates the law and its own rules, is producing the opposite result,” stated Eastwood.  “Even though the department's actions have produced serious financial challenges for The Scooter Store, this is about more than reimbursement to The Scooter Store. We are fighting for a fair and predictable process to ensure that patients continue to receive the medically necessary equipment prescribed by their doctors.  It both improves the quality of the patients' lives and saves the taxpayers money.”