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Sunday, August 17, 2014

The Wheelchair Scam

At The Washington Post, David A. Farenthold writes about a scam that hit Medicare:
The wheelchair scam was designed to exploit blind spots in Medicare, which often pays insurance claims without checking them first. Criminals disguised themselves as medical-supply companies. They ginned up bogus bills, saying they’d provided expensive wheelchairs to Medicare patients — who, in reality, didn’t need wheelchairs at all. Then the scammers asked Medicare to pay them back, so they could pocket the huge markup that the government paid on each chair.
A lot of the time, Medicare was fooled. The government paid.
Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and “scooters” for 2.7 million people. Today, the government cannot even guess at how much of that money was paid out to scammers.
Now, the golden age of the wheelchair scam is probably over.
But, while it lasted, the scam illuminated a critical failure point in the federal bureaucracy: Medicare’s weak defenses against fraud. The government knew how the wheelchair scheme worked in 1998. But it wasn’t until 15 years later that officials finally did enough to significantly curb the practice.
Today, even while the wheelchair scam is in decline, that same “pay and chase” system is allowing other variants of the Medicare equipment scam to thrive.
They aren’t perfect. But they work. In Brooklyn, for instance, the next big thing is shoe inserts. Scammers bill Medicare for a $500 custom-made orthotic, according to investigators. They give the patient a $30 Dr. Scholl’s.
In Puerto Rico, the next big thing seems to be arms and legs.
In one case there, two dozen companies billed Medicare for $5.3 million in prosthetic legs inside of a year. In many cases, their “patients” had no record of amputations in their medical history. Many of them didn’t even live in Puerto Rico. But Medicare paid for the legs.