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The Scooter Store Case: Can We Defeat Fraud Without Punishing Innocent Patients?

Updated on January 25, 2014
What happens when you can no longer walk?
What happens when you can no longer walk?

Is It Medicare Fraud?

When the FBI and Texas law enforcement launched an all-out raid on The Scooter Store in New Braunfels, Texas, the hidden and extremely lucrative world of Medicare fraud was thrust into public view. With Obamacare and it's gargantuan price tag approaching ever nearer, we can expect more raids of this sort.

This brings us, however, to a quandary – how do we protect those who really deserve mobility services while eliminating fraud? Like most government restrictions (yes, we will see some stemming from this raid), the most needy and deserving Medicare recipients will bear the brunt of the punishment.

April 2013 Scooter Store Update

This is quickly devolving into a major mess. Ex-workers filed suit against The Scooter Store after the company filed for bankruptcy. There is a chance the company will settle the disputes, but the verdict is still out on whether criminal charges will be filed. Meanwhile, the The Scooter Stores is scaling back operations and there is a chance they will be selling off some of their mobility equipment. This story just keeps getting bigger and bigger.

Sit-to-Stand Lifts - Essential for Moving Patients that Cannot Stand or Walk

My Story

My elderly father is in a power-chair – a spiffy new one provided by The Scooter Store. This is his second power-chair, the first one, a Little Rascal, shelled a few months ago, and since it was over 6-years-old and the Little Rascal company was no longer in business, the search for a new chair began.

If anyone needs a power-chair it is my father. At 93, he can no longer walk or even support his weight to stand. My mother, who is 82 and none-too-spunky herself, cares for him completely, moving him from bed to pot to power-chair, via a sit-to-stand lift. Were it not for my mother’s insistence on caring for him – he would have been relegated to a nursing home years ago.

For my father, the power-chair is not only the purveyor of the last vestige of his independence; it’s the only thing standing between him and cost-prohibitive professional care. Although his body has betrayed him – his mind, the mind of an encyclopedic genius, is as sharp today as it ever was. Living in a nursing home – for my father – would be a death sentence.

How much go-power do you need?
How much go-power do you need?

Mobility Chairs from Amazon

Enter The Scooter Store

As the search for a new powerchair began my mother contacted numerous mobility equipment suppliers and the endless medical appointments began as well. You see, Medicare requires an astronomical amount of professional intercession in the process before they will supply the chair to the recipient. With an old van, equipped with an even older, rickety and untrustworthy lift, I drove my parents to see their family doctor, physical therapists and back to their doctor…repeatedly.

Reams of papers were filed. Hundreds of questions pertaining to my father’s health and physical ability were asked – most at least five times. After three months, a suitable chair (or so we thought) arrived at my parents’ door and I was there for the delivery. Unfortunately, the chair was not adequate, it caused my father substantial pain because the back was not adjustable and his curved spine pushed him so far forward he nearly fell out. But that’s not what this is about. This is about the conversation I had with The Scooter Store salesman/deliveryman.

Prior to the delivery, I looked on The Scooter Store website and perused the available chairs for sale to the public. The chair that was (supposed to be) on its way, sold on the site for around $3,500, which I thought was probably in the right range for the quality. I’d not yet seen the chair, but the reps had described it so I had a pretty good idea.

Bait and Switch?

Imagine my surprise when the delivery man unloaded a rinky-dink-looking chair from the back of his van. I believe I said, "that’s kind of rinky-dink looking" aloud. It was certainly not the chair we were led to believe would be delivered.

Once inside, The Scooter Store rep (he was quite personable) presented my parents with the paperwork and colorful pamphlets of accessories they could order. I browsed the pamphlets, noting the same chairs I’d seen online – and about the same prices. The chair the rep brought sold for $2,900 in the pamphlet so I was concerned when he asked my parents to sign papers listing the chair value at nearly $6,000.

“Whoa, wait a minute,” I said. I tend to blurt out my thoughts. “Why does it say this chair sells for less than $3,000 in the pamphlet and yet on this paper you’ve listed its value at nearly double that amount?”

The rep told me that the pamphlet represented the amount charged to Medicare. It was “special pricing” for Medicare. That was obviously bull and a horrible lie, but I shut my mouth. I intended to notify Medicare after my father got his chair. We were currently pushing him in an old manual wheelchair, which was hard for my mother to push, and it forced my father to sit in one spot for hours at a time. Not a good situation -- his feet were swelling. When his old chair was operable, he could drive it into his bedroom where my mother could move him to a recliner for a couple of hours respite.

So, I shut my mouth about the price fiasco, but I did insist that my mother not sign the paperwork until my father tried out the chair. The chair, as I mentioned earlier, was not suitable, and the rep took it back at my insistence. He ran over my father’s portable grill on the way out. Oh well, such is life. It looked like we were in for a longer stint of using the push wheelchair. My parents were very disappointed, but they understood.

This is the power chair my father got after months of appointments and disappointments. Is it worth $16,000?
This is the power chair my father got after months of appointments and disappointments. Is it worth $16,000?

The Powerchair Search Continues

Our focus in the days after not accepting The Scooter Store’s bait-and-switch chair took a new direction. We scoured local ads for a used chair that would temporarily serve to move my father until we could order a suitable one. We found a couple of scooters, but they required the ability to steer via a two-hand steering wheel system. That was out – my father arms and grasp are shot. He needed the little steering lever that did not require leaning forward.

In a couple of weeks The Scooter Store contacted my parents again. They could get my father the right chair – a few more medical appointments would be necessary however. With nothing to lose, except my time chauffeuring my parents around, we decided to give The Scooter Store another chance. Plus, we were batting out on the used chair scene.

Three tough months later, The Scooter Store (different rep) delivers an amazing chair that once-again gave my father the freedom to move independently from room to room. I was there for the delivery and I stayed long enough make sure my father was not in pain, that he could operate the chair and that it would serve his purposes. It did. Pressed for time, I left, not waiting to watch my mother sign the papers. We knew it would be completely paid for by Medicare and my parents’ supplementary insurance policy. I didn’t know until later that the papers said the chair cost over $9,000.

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Twists and Turns

Two weeks ago (mind you, this is about three months since my father got the chair) my mother got a bill from The Scooter Store for about $170. I asked to see the bill and she showed me an itemized list of expenses for the chair. The Scooter Store had billed Medicare and my parents’ supplementary insurance over $16,000 total! What the heck, I thought. Where did that additional $7,000 come from? It was hard to tell from the cost breakdown, but my mother’s main concern was the $170 charge. Call them up, I told her. They assured you that the chair cost was covered and you already paid out-of-pocket for the little tote bag attached to the side.

She called the next day and customer service rep was apologetic. The charge was some sort of a duplicate fee that they’d not charged Medicare. I’m telling you this second-hand, I wasn’t there when my mother made the call. They assured her that she still owed nothing and she was happy.

Where Do We Go From Here?

So what is the answer? There is obvious waste, if not outright fraud, being perpetrated by some mobility equipment companies. The need for folks like my dad, however, is so great that it will be a shame if any are denied access to this technology because some companies are intent on padding their bills.

As the era of Obamacare marches closer, the risk of fraud, along with the cost we all pay for the fraud will increase substantially. How do we provide necessary services for those who truly need them without being fleeced by unscrupulous companies? I’m not condoning or condemning what The Scooter Store did until I know exactly how they charged for the chair. They did many over-the-phone consultations, acted as intermediary between my father and his doctor, and set up physical therapist exams. I know a lot of work was going on behind the scenes. They have to pay their reps just like any employer does.

Greater regulations will follow, but believe me – as soon as they come down the pipe, those with a mind to defraud will figure out how to get around them. Those, like my father, will spend months dealing with red tape, trying like mad to comply with the already-astronomical rules.

There has to be a better way. Let me know if you find it.

Have You Experience Medicare or Other Insurance Fraud?

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