Wheeler Dealer

Sunday, November 30, 2003

Harris County providers feel the squeeze
HOUSTON, Texas - Hundreds of legitimate providers here have felt the consequences of rampant fraud, and now many also are feeling its repercussions as CMS officials target Harris County with its Wheeler Dealer crackdown.

In its 10-point campaign to curb abuse, CMS placed significant requirements on providers in the Houston-area.

“It is just incredible what they have done to us,” said one Houston provider who asked to remain anonymous.

Despite his store’s good reputation, the provider feels unduly targeted by the campaign’s provisions.

The concerns center on the Wheeler Dealer requirement that all payments for motorized wheelchairs out of Harris County to be individually approved by a special CMS task force at the Dallas Regional Office.

Every supplier that billed a K0011 in Harris County falls under review, which the provider said is leading to longer reimbursement periods.

“We were told we were going to be under review indefinitely, not because we have a high denial rate or because we did something wrong, but because of our zip code and where we choose to do business,” said another provider.

Officials at CMS’’s Dallas Regional Office say they have seen no significant increase in the billing periods as a result of the 10-point plan. They did say that providers are being asked to submit additional information with their claims, however.

“Palmetto reviews the claim and then sends it here,” said an official at the Dallas office. “It’s just another set of eyes making sure the documentation is there.”

Other providers have weather the storm and are more excited to see evidence of fraud diminishing.

“That’s just everyone having to pay a little bit of a price for all those bad apples,” said Larry Rice, general manager of Houston-based Wheelchair Shop.

“Any time funding gets a little tight we all go to whining and crying. I have to be very frank about this because I have done it too,” he added.