Scooter Store sues over disputed claims

Monday, February 28, 2005

SAN ANTONIO - The Scooter Store sued CMS in federal district court in late January, claiming the government has illegally withheld reimbursement for 101 power wheelchairs and scooters provided between 2000 and 2003.

The Scooter Store’s case revolves around the belief that Medicare must pay claims based solely on information provided in the certificate of medical necessity. CMS and the DMERCs have no legal authority to request medical documentation beyond the CMN during the claims review process, the Scooter Store contends.

Maximum Comfort, a provider of power wheelchairs in Redding, Calif., used that argument in a similar court case against CMS and last summer received a ruling in its favor. That ruling is binding only in the Eastern District of California, but it does bolster the arguments of providers in other parts of the country battling similar disputes with CMS.

“We feel strongly enough about the Maximum Comfort case and about the intelligence of the guys in Congress and at CMS and the medical directors back in 1996 when they set that up to be the rule and the law,” said Scooter Store President Mike Pfister.

The Scooter Store contends that the Department of Health and Human Services 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, according to 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,” according to Valerie Eastwood, an attorney representing the Scooter Store.

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.