Washington Post Story on PMD Fraud Confounds Industry
- By Laurie Watanabe
- Aug 27, 2014
An Aug. 16 Washington Post story about years-old power wheelchair fraud has confounded industry experts, including some of those interviewed for the piece.
The story, by Post reporter David A. Fahrenthold, rehashed well-documented power wheelchair fraud schemes starting in the 1990s and carried out by people who entered the DME industry with the express intent of ripping off Medicare.
In his story "A Medicare Scam that Just Kept Rolling," Fahrenthold pointed out that culprits signed up as DME suppliers, then billed Medicare for huge numbers of power wheelchairs for beneficiaries who didn't need them. By manipulating and bribing seniors, partnering with corrupt physicians and using "patient recruiters," scammers exponentially raised the numbers of power wheelchairs that Medicare purchased starting in the mid '90s.
Among the people Fahrenthold interviewed for the story were Don Clayback, executive director of NCART, and Mark E. Smith, public relations & outreach manager for Quantum Rehab.
When Fahrenthold's story was published, both Clayback and Smith were surprised by what it said.
Repeating Well-Known History
The Post story recounted fraud schemes that Fahrenthold noted began in Miami about 20 years ago.
He described how Medicare beneficiaries were rounded up by recruiters and issued generic power wheelchair prescriptions by doctors who were paid off by the scammers. Fahrenthold quoted witness testimonies of beneficiaries who were unwitting participants in the schemes.
Fahrenthold's story included photos of an unused power chair sitting in a garage. Another unneeded chair served as a seat for a beneficiary's huge teddy bear.
"Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and 'scooters' for 2.7 million people," the story said. "Today, the government cannot even guess at how much of that money was paid out to scammers."
None of this is news to the people in the DME and complex rehab technology industries who lived through those times, as well as through the Centers for Medicare & Medicaid Services' (CMS) "Operation Wheeler Dealer" program in 2003. It was aimed at combating power mobility device fraud.
The DME industry is also years-deep into Medicare's controversial national competitive bidding program, which sprung from Wheeler Dealer and which numerous healthcare advocates have said is making it difficult for Medicare beneficiaries with legitimate medical needs to secure durable medical equipment and repair services.
Clayback and Smith were among industry members confused as to why Fahrenthold's article repeated well-known history without shedding new light on the subject - especially because there's plenty of new activity to report.
The Impact on Legitimate Power Chair Claims
Speaking by phone with Mobility Management, Clayback said Fahrenthold had been referred by NCART by RESNA, and that Fahrenthold reached out to Clayback via e-mail to ask for an interview.
In the e-mail that Clayback provided to Mobility Management, the Washington Post reporter said, "I was hoping to talk with you today about CMS's current crackdown on wheelchair fraud, and what that's meant for people who have a legitimate need for these chairs."
Clayback said he found Fahrenthold's question "interesting," and that he spent about 20 minutes speaking to the Post reporter.
"I could tell he had done some homework and talked to some other people, but he had pieces and not the whole story," Clayback said in recounting their conversation. "He wanted to know the whole problem with power wheelchairs, and so I gave him some history on fraud and abuse in terms of what went on. We talked about the process that's involved when someone gets a wheelchair -- the current process."
That includes, Clayback said, policies that Medicare implemented in response to fraud.
"I talked to him about some of the changes that were put in place: the requirement for a specialty evaluation, the requirement for the face-to-face visit, the prior approval program that's being used on a demonstration basis," Clayback said. "I talked to him about the fact that the industry is committed to making sure there are safeguards around the program."
Clayback followed up the conversation, which he described as "general but focused," by sending Fahrenthold additional information that included current industry efforts to create a separate Medicare benefit category for complex rehab technology.
"The industry is committed to protecting the program," Clayback said he told Fahrenthold. "We're fully supportive of the changes that are in place, and the important thing is to protect access so that changes that are put in place don't impinge access. That the safeguards are in place, but people can still get what they need. That documentation requirements aren't overly onerous. And that the people's ability to get what they need is preserved."
Fraud by People with Disabilities?
Fahrenthold also talked to Mark Smith, an industry veteran who's used a power wheelchair since childhood due to cerebral palsy.
In an interview with Mobility Management, Smith said he spoke to Fahrenthold for about an hour by phone on July 21, and that the reporter asked him about people with disabilities who fraudulently obtained power wheelchairs from Medicare.
Smith said that line of questioning confused him, since people with legitimate mobility-related conditions could qualify for power wheelchairs legally and would therefore have no reason to resort to fraud.
Smith took notes during his Washington Post interview and forwarded those notes to Mobility Management. He said Fahrenthold also "asked about Operation Wheeler Dealer, and my response was that it had nothing to do with those of us with disabilities needing mobility products."
Like Clayback, Smith said he also discussed the ATP and Seating Mobility Specialist (SMS) qualifications to Fahrenthold to explain current power wheelchair medical need and documentation requirements.
"My notes truly don't do justice to just how in-depth I explained the entirety of the struggles those with disabilities go through to get a life-sustaining power chair funded," he added. On his Powerchair Diaries Web site, Smith discusses his conversation with Fahrenthold in detail.
The final Post story, however, contained no quotes from either Smith or Clayback, and they both said none of their comments were used as background material for the story.
The story does say, "Now, the golden age of the wheelchair scam is probably over." Later in the same paragraph, the story said Medicare took 15 years "to significantly curb the practice" - thus acknowledging how long ago the fraud happened and how old the story actually is. Nearly all of the story's statistics are more than 10 years old; one statistic mentioned in the story is 20 years old.
Fahrenthold did include figures showing that Medicare spent $190 million on power chairs in 2013 compared to nearly $1 billion 10 years prior.
"That's the good news," Fahrenthold wrote about the starkly lower utilization numbers.
Missing is any extrapolation of what those numbers could suggest - for instance, that now, not all beneficiaries who legitimately need power chairs are getting them.
Clayback said, "I didn't want to come across as cavalier, like 'That was 10 years ago and you shouldn't be reporting about it.' Because I could see someone saying, 'The fact that the government spent x number of dollars incorrectly is a story no matter when it happens.' I've been trying to stick to our main points: It was old news and it's been well documented, but more importantly, that's not what's going on today."
Contacted by Mobility Management regarding why he excluded the comments from Clayback and Smith, and why he chose to focus on old cases of fraud without including more current information as well, Fahrenthold replied via e-mail, "In this case, I'm just going to let the story speak for itself."
After the story was published, Clayback said he contacted Fahrenthold.
"What I tried to convey in my message is that these stories hurt people," Clayback said. "They give a false impression. That's what my concern is, that someone reading that may think anybody can get what they want, so consequently the challenges we're facing on a federal and state level are only going to get worse because now people hear 'power wheelchairs,' and they think of people getting something they really don't need."
In contrast, Clayback had hoped for a story that, if it started with fraud in the 1990s, would end with the fact that the Medicare utilization pendulum has arguably swung too far in the opposite direction.
"I thought the angle he was reporting on was the whole picture: There were these big problems, people were getting away with millions of dollars. CMS responded, over the last four or five years they put these things in place, and as a result, utilization has gone down.
"I just felt it could have been a little more balanced. That's our issue with the article."
Laurie Watanabe is the editor of Mobility Management. She can be reached at email@example.com.