“My wheelchair is my legs, without it I would die.” Franklin DePaula, ICS Member
Before you read this post, please take a minute to watch this story from CBS News, headlined: “Are Power Wheelchair Companies Ripping Off the Government?”
The piece is focused on the Scooter Store, and the conclusion is that it has SUCCESSFULLY been ripping off the government for years, receiving over 1.8 million dollars in payments in error.
The whistle blower a former Scooter Store employee, attests that getting a scooter at the Scooter Store is as easy as finding a unethical doctor who will write a prescription; submitting incomplete documentation, government fines for fraud and errors be damned; or simply haranguing physicians until they sign off on a wheelchair order just to be done with the harassment.
A deeply concerning reality, these cases of fraud are not only costing the government millions each year, but they are creating significant hurdles for patients who genuinely need complex mobility devices to lives their lives independently, like many of our members at Independence Care System. On the surface The Scooter Store and ICS seem do similar things – provide wheelchairs to people with mobility impairments. The difference is in the evaluation and customization that people with physical disabilities need to live independently. You can compare this to buying a suit off the rack and having a tailor make one for you. When you need help getting to the supermarket because you experience fatigue and you can move in and out of the mobility device because you can stand and walk, your needs are significantly different than someone with quadriplegia that needs specialized seating to prevent wounds and a sip and puff system to make the wheelchair move.
Rehab professionals like me have been concerned about the Scooter Store for many years. In particular, their practice of marketing directly to the consumer and participating in the purchase process has led to lots of people getting mobility devices they do not need and/or that do not fit their lifestyle. Their business is based on volume, selling as many scooters/consumer power chairs as possible. Because the equipment they are ordering is not as sophisticated as equipment required for people with significant disabilities, the evaluation process and the professionals doing the evaluation are of little concern to the Scooter Store. The result: millions of dollars worth of equipment sits idle all over the country.
The truth is, for most providers of rehabilitation equipment that must be customized to the bodies of people with disabilities who have complex mobility needs; the process is onerous and cumbersome. We have had physicians say to us, “I hope this call is NOT about a wheelchair” because if you are doing it right, it is not easy—for the physician or for us. To deal with fraud and abuse, the Center for Medicare and Medicaid Services has pulled out a cannon to kill a fly; it has put mountains of bureaucratic barriers in place instead of directly dealing with companies that repeatedly skirt the rules, get a slap on the wrist in the form of fines that have no real impact on their practices, and retain their right to continue ordering government subsidized mobility equipment. Because we work with a much lower volume and because the wheelchairs we order are very complex tools that cost quite a bit, we work preemptively to make sure that Medicare will approve the purchase. That’s long been the situation in highly skilled and experienced rehab departments, like ours at Independence Care System.
Those of us who have been following the rules have had to work HARDER AND HARDER to get wheelchairs approved. Many of the “errors” reported in the CBS story are in fact clerical errors – things like a difference in dates, illegible signatures etc. and these clerical errors get the wheelchair order sent back to the clinician – sometimes several times. Why? The system is that complicated. The outcome? Some people wait a very long time for equipment – sometimes years. Creating a difficult process for getting equipment has a disproportionate impact on ICS members and other people with disabilities that rely on complex medical equipment to live independently in the community. The Scooter Store sells a consumer convenience product – something that mostly helps people who need minimal assistance to get around. Mobility equipment for a person with a disability is not a convenience, it is a necessity and the current system does not take that into account.
As a Physical Therapist, I have seen first-hand the life-changing impact wheeled mobility can have on a person’s life. At Independence Care System, we have created a wheelchair evaluation and purchase program that is looked at as a model and was used as the foundation of federal legislation that was proposed last year. Many disability rights groups including Christopher and Dana Reeve Foundation, the National Spinal Cord Injury Association (a program of United Spinal Association), National MS Society, long with NCART (National Coalition for Assistive and Rehab Technology) and the NRRTS –(National Registry of Rehabilitation Technology Suppliers), support the passage of federal legislation to add a separate benefit category for durable medical equipment needed by people with physical disabilities that take into account the highly individualized nature of equipment for people with disabilities like paraplegia, quadriplegia and Multiple Sclerosis.
At ICS, we take our wheelchairs seriously. We know what they mean to our members. We work hard to get our members a wheelchair that works for their body, disability and lifestyle. We know that no two people are the same and that their wheelchairs can’t be the same either – one size does not fit all. Because we think differently about wheelchairs, our award-winning wheelchair program is unmatched in New York City. Stories like the one on CBS News are important because they shine a light on practices that should be stopped immediately. We applaud efforts to stop fraud and abuse in the Medicare program. But we also know that creating a labyrinth of bureaucratic processes does not stop fraud and abuse for the companies only in this business to make money; it punishes the wrong people.
Although the Scooter Store commercials make it seem like getting a wheelchair or a scooter when you have a disability is as easy as ordering a Ginsu knife, the reality for most people with physical disabilities is much different. Thoughtful professional evaluation is a key component to getting a wheelchair that promotes independence and good health outcomes. Like many issues, fraud and abuse in Medicare requires a multi-pronged strategy that includes coming down hard on fraudulent operators and carving out Complex Rehab Equipment so people with disabilities who require a wheelchair to live their lives get the wheelchairs they need.