April 30, 2005 in Nation/World

Justice sues Scooter Store

Associated Press
 

WASHINGTON – The Justice Department announced Friday it is suing the Scooter Store, alleging the company submitted fraudulent claims to government health care programs to obtain reimbursement for power wheelchairs rather than much less expensive power scooters.

The New Braunfels, Texas-based company has billed Medicare for claims worth more than $400 million since 1997.

The government’s suit, filed in federal court in San Antonio, Texas, was a counterclaim to a complaint by the company. The company is trying to overturn decisions by the Department of Health and Human Services disallowing hundreds of reimbursement claims for power wheelchairs in cases where HHS concluded the company failed to establish a medical necessity for the claims.

The Justice Department says the company engaged in a mass marketing campaign, assuring Medicare beneficiaries the scooters would be paid for by the federal health care program.

Once potential customers contacted the company on a toll-free number, callers were told Medicare would pay only for much more expensive power wheelchairs, the lawsuit says.

As a result, Medicare and Medicaid paid for more expensive mobility equipment than the customers desired or needed, the government alleges. Customers who said they wanted to return the wheelchairs and get a scooter instead were often told by the company they could not do so because it was the only equipment Medicare would pay for, the department said.

In response, the Scooter Store said the government’s complaint “indicates that some officials are more interested in second-guessing the conclusions reached by doctors than they are in making sure that qualified Medicare beneficiaries have access to the medical equipment their doctors say they need.”

Scooter President Mike Pfister said the government has applied inconsistent standards, violated the law and wrongfully denied claims.

A year and a half ago, officials with the government health care program for 40 million older and disabled people ordered more scrutiny of claims for power wheelchairs, whose prices range from $5,000 to $6,000 or more, depending on accessories. The program ordered its insurance contractors to enforce strictly a policy that normally limits reimbursements to those unable to walk.

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