Editor's Note

Same Old Same Old

Medicare ScamI am scratching my head over the Aug. 16 Washington Post article “A Medicare Scam that Just Kept Rolling” by David Fahrenthold.

As its headline portends, the past-tense story is about well known fraud involving consumer power mobility devices (PMD) and — I’m making air quotes here — “Medicare DME suppliers.” There’s talk of an exponential rise in PMD claims, practically overnight. Beneficiaries coerced or manipulated. Brand-new power chairs collecting dust in garages. The Scooter Store. You’ve heard this tune before.

“Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and ‘scooters’ for 2.7 million people,” Fahrenthold wrote. “Today, the government cannot even guess at how much of that money was paid out to scammers.”

Unfortunately, the story recaps what happened years ago without shedding new light. And there is new light: Originally slow to act, the Centers for Medicare & Medicaid Services (CMS) has since rolled out a competitive bidding program, layers of audits, and required face-to-face visits between beneficiaries and physicians. There’s a prior authorization demonstration in seven states, soon to be rolled out in 12 more.

A few of CMS’s actions — the demo project being the poster child — are working well. But many others, say consumer and healthcare advocates, are so vague and poorly planned that they hurt the very beneficiaries Medicare is supposed to be protecting. There’s been overcompensation.

That would have been a good story to report.

In fact, that seemed to be exactly the story Mr. Fahrenthold wanted to tell. He talked to NCART Executive Director Don Clayback, saying in an e-mail that he hoped to discuss “CMS’s current crackdown on wheelchair fraud, and what that’s meant for people who have a legitimate need for these chairs.”

Don said he spent about 20 minutes talking to the author and detailed current PMD acquisition processes — i.e., how new(er) checks and balances help ensure PMD scrips aren’t being fabricated for beneficiaries who jog up flights of stairs to pick them up from conspiring physicians.

Mark E. Smith, the marketing guru at Quantum Rehab and a power chair user since childhood, spent an hour talking to Mr. Fahrenthold and also described the acquisition process. But you’d never know it from the Post article, because Mark and Don aren’t quoted. Their comments don’t even appear as background exposition.

No one still in the industry downplays the fraud committed; the suppliers who are left have paid a steep price for sins they didn’t commit. So it’s disappointing that the Post’s superficial effort uses old information to re-blacken the industry’s eye. There’s a much more timely story here: that beneficiaries who truly need power wheelchairs, or who need their PMDs repaired, are stranded because Medicare has drastically reduced the number of suppliers it works with, and has made it nearly impossible to get a Scooter Store-issued vehicle repaired.

On a practical “been-there” level, I’m also confused as to why a reporter would spend so much time interviewing experts, then not quote them. Did the assignment change? Did the editor force him to switch story topics?

That’s what I asked Mr. Fahrenthold. He told me in an e-mail, “I’m just going to let the story speak for itself.” That’s too bad. The story could have said so much more.

This article originally appeared in the October 2014 issue of Mobility Management.

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