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Medicare self-fraud
Old 03-02-2009, 01:56 PM   #1
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Medicare self-fraud

Nine months ago my 93 year old mother's doctor ordered a wheelchair for her from Medicare. This was not for a temporary injury, it's a permanent situation because at her age she has a hard time getting around. She got a regular, black, push-style wheelchair, and we never thought more about it. Recently she asked me to look at a Medicare explanation of benefits statement she received, and I noted Medicare was charged $237 for renting that wheelchair for that month. I then found out she had been receiving those statements over the last nine months and didn't know what to do with them, so she placed them in a drawer.

I called Medicare to tell them this was a mistake, the wheelchair should have been bought back then, it didn't cost more than $250, and a mistake must have been made. I was shocked at their response, they basically didn't care how much was paid, as long as it was under the Medicare allowed limit for a wheelchair. I then complained that they've already paid $237x9= $2133 for a $250 wheelchair over the last nine months, and they should just buy it. Again, they didn't care, the billed amount is under the Medicare limit for a monthly charge for a wheelchair. But they said I could call the wheelchair company and ask that it be made a purchase instead of a rental.

I told them that if they rely on me to make that call, they are commiting a self-fraud against Medicare and taxpayers, and with that type of cost accounting it's no wonder Medicare is going bankrupt. Their only answer, again, was to hide behind the allowed limits.

I don't think we're in Kansas anymore.
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Old 03-02-2009, 03:50 PM   #2
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Yep. No one has an interest in making things right. Writing it up as a rental was probably easier than writing it up as a purchase (no need to prove the condition was long-term). The medical equipment company sure had no reason to let out a peep. You heard what the Medicare rep said--if they won't even bother to change it going forward, you can bet no one will invest the 15 minutes it would take to get the back-charges returned from the rental company for the previous months.

Yet, if your Mom had needed for Medicare to spend $10 on an unusual item, you can bet it would have been nearly impossible.

Luckily, once we get to the nirvana of a single-payer system here in the US, everything will be much better. All the warmth and responsiveness of the DMV . . .
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Old 03-02-2009, 04:13 PM   #3
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Perhaps you should send a note here:

Accountability and Transparency | Recovery.gov

Our President has said:

Quote:
"We are asking the American people to trust their government with an unprecedented level of funding to address the economic emergency. In return, we must prove to them that their dollars are being invested in initiatives and strategies that make a difference in their communities and across the country. Following through on our commitments for accountability and openness will create a foundation upon which we can build as we continue to tackle the economic crisis and the many other challenges facing our nation."

The President has made it clear that every taxpayer dollar spent on our economic recovery must be subject to unprecedented levels of transparency and accountability.
While the medicare $ are a different pile of money from the stimulus budget, a dollar is a dollar. Money is fungible.

So President Obama should be interested in hearing how these $ are being wasted. This is a prime example of why so many people are so skeptical of the govt spending our money, and very likely why the market keeps dropping. We wouldn't make that stupid rent/buy decision on that wheelchair, why should the govt do it with our money? Esp when that scenario is playing out all over the country.

He should not have said "every taxpayer dollar" if he didn't mean it. So 2,133 taxpayer dollars surely must get his attention.

Let is know what kind of response you get. We can all hope that is a good and effective one that brings about change in Washington.


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Old 03-02-2009, 07:08 PM   #4
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Perhaps you should send a note here:
-ERD50
I think I'll do that, and will let you know what they say. I called the wheelchair company today, and the situation is worse than I thought, assuming they're telling me the truth.

According to them, you can't buy a wheelchair with medicare, you can only rent one for up to 13 months. So they rent it at $237 a month, and after 13 months it's yours. So in essence they are charging Uncle Sam $237 x 13 = $3081 for at best a $250 wheelchair. I say at best, because I found the same wheelchair at this site, listed at $249 on sale for $110.
Drive Medical Spirit Standard Wheelchair - SpinLife Standard Wheelchairs

I wonder what hair-brained accountant came up with the brilliant idea that renting wheelchairs for 13 months instead of buying them was the best way to manage taxpayer money?

And samclem is right, if the situation was reversed and she needed a $10 item that wasn't on the Medicare list, they would fight tooth and nail over it.

Update: This is getting better and better. I found the following on a medicare site. If anyone can decipher what this means, you're better than me. I think this means you can't buy a wheelchair, you can only rent it, and if you find a really good wheelchair they won't let you have it because you could just buy it (eh). Or, said another way, they will pay as much in rental fees for a cheap wheechair than they would for an expensive one, but they won't authorize an expensive one because you could just buy it. My head hurts:

Manual Wheelchair
You may need a manual wheelchair if you can’t use a cane or walker safely. The
wheelchair can’t be a high strength, ultra-lightweight wheelchair that you can buy
without renting it first.

http://www.medicare.gov/Publications/Pubs/pdf/11046.pdf


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Old 03-02-2009, 08:38 PM   #5
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Getting curiouser and curiouser, no?

$237/month rent for a wheelchair you or I could buy for $139 (slight miss-type there, it was $110 off)? Wouldn't you think that someone with the buying power of the UNITED STATES GOVERNMENT could get a better price than you or me?

I could see the logic of requiring you to rent if the wheelchair price was far greater than the average length that people rented them. Maybe at one time it was.

Not to derail this thread too much, but....
OK, so here's a part-time employment opportunity for us ER LBYM types. Identify stuff like this, the govt gives us 33% (tax free) finders fee on the first year's savings. Who better to do it? Who couldn't use some cash to build up the portfolio about now? And wouldn't that cash help stimulate the economy? And wouldn't it actually go towards LOWERING the debt long term (think of the grandchildren! let's see if that works for me?).

Seems like a WIN-WIN-WIN to me. Not to be immodest, but it sounds like a better plan than anything I've heard out of Washington this year. Hmmmm, maybe contact that Rick Santelli guy - get some traction on this?

I'm thinking of saying I'm only half joking, but the more I think about it, I'm not. I'm serious.
-ERD50
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Old 03-03-2009, 06:35 AM   #6
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OK, so here's a part-time employment opportunity for us ER LBYM types. Identify stuff like this, the govt gives us 33% (tax free) finders fee on the first year's savings.
-ERD50
Good idea, but I have a better one. Wanna go into the medicare wheelchair rental business?
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Old 03-03-2009, 07:54 AM   #7
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Good idea, but I have a better one. Wanna go into the medicare wheelchair rental business?
That was my *first* thought , but somehow, I'd end up in jail for that, while these guys do it as a "service" to the public.

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Old 03-03-2009, 08:33 AM   #8
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Good idea, but I have a better one. Wanna go into the medicare wheelchair rental business?
Sounds good. Health care is pretty recession-proof...
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Old 03-04-2009, 05:14 AM   #9
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Yep.
Luckily, once we get to the nirvana of a single-payer system here in the US, everything will be much better. All the warmth and responsiveness of the DMV . . .
Yep, as we used to say about Hillary Care: If you think health care is expensive now, wait until it's FREE!
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Some independent confirmation:
Old 03-05-2009, 10:22 AM   #10
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Some independent confirmation:

Quote:
Originally Posted by FinallyRetired View Post
Nine months ago my 93 year old mother's doctor ordered a wheelchair for her from Medicare. ....
I had a conversation with a friend yesterday. He related your story almost word for word, regarding his MIL and wheelchair situation.

In addition, he actually did go out and buy one, the *exact* model number of the one Medicare was renting. It was $90, and that included overnight shipping to his door-step (a BIG box). He felt it was worth $90 to have one at their home, to save them from lugging hers back and forth.


$90 PURCHASE, versus >$200/month rental

He also mentioned (and I won't get this exactly right, so just generally speaking), that the rental companies had quite the "sales pitch" ("rental pitch"?) on why you should rent instead of buy. Something about a lifetime limit of one wheelchair purchase per person, so rent now, and "save" the purchase for when you qualify for a motorized wheel chair, because they will sell you one of those for $10,000!

MediCare is what is considered a "single payer" system, am I correct?

< off to wiki/google.....and.....>

Ah, yes:

http://en.wikipedia.org/wiki/Medicare_(United_States)

Quote:
Medicare operates as a single-payer health care system.[1]
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Old 03-05-2009, 11:05 AM   #11
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ERD50......

Yeah, I get the shivers when I hear examples such as the wheel chair rental situation you and FinallyRetired related. Also when I watch television commercials for products where the vendor wants to send the product to the Medicare recipient free and bill Medicare directly. Each one I see tells me some sharp eyed business person has spotted an opening in the system where they can profit at taxpayer expense.

There are pros and cons to national vs private health insurance. I'm sure a con of any national system is that it will be less effective at controlling these kind of scams than a private provider would be.
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Old 03-05-2009, 11:52 AM   #12
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There are pros and cons to national vs private health insurance. I'm sure a con of any national system is that it will be less effective at controlling these kind of scams than a private provider would be.
But does it need to be so? Maybe it would be just the opposite?

Over on the Socialized Medicine thread, samclem outlined a system a few of us have talked about. Basically, a voucher from the govt that you use to buy insurance from any company in the program (to be in the program, you have to take all applicants, etc).

Now, wouldn't each of those companies be competing to offer the best coverage at that price? Wouldn't that mean weeding out bad decisions like paying $237/month to rent a $90 wheelchair?

What really gets me about the wheelchair thing is, it is so obviously wrong. There is no grey area here, it is not some complex health issue, or something with ethical questions, there is nothing to debate. It's not conservative versus liberal. It's just wrong. It wouldn't even make it to the math section of "Are You Smarter Than a Fifth Grader?". And wheelchair use is so common, not some obscure, rare procedure. Imagine how rampant fraud like this must be throughout the system.

whew.... OK, the silver lining in this is....

With that much waste in such a transparent area, just imagine how much money we could save with the right measures in place. Maybe we *can* have our cake and eat it too? Maybe we *can* have affordable health care for all, and actually spend less money (net) than we do today?

Do I hear John Lennon's "Imagine" paying in the background?

-ERD50
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Old 03-05-2009, 12:05 PM   #13
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I had a conversation with a friend yesterday. He related your story almost word for word, regarding his MIL and wheelchair situation.
So let's give the govt some credit here. They may pay 10X what something is worth, but they are consistent about it.

Quote:
Something about a lifetime limit of one wheelchair purchase per person, so rent now, and "save" the purchase for when you qualify for a motorized wheel chair, because they will sell you one of those for $10,000!
So if you buy your own for under $200 you lose. If you let them pay several thousand you not only win that wheel chair, you get the bonus prize of a $10,000 motorized one in the future!

I definitely need to go into the wheelchair rental bidness.
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Old 03-05-2009, 12:08 PM   #14
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ERD50.

Well I hope you're right. I just normally associate anal attention to detail to avoid paying an unnecessary penny to private systems and, shall we say, "looser standards" to public systems. I suppose I'm painting with too broad a brush.
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Old 03-05-2009, 12:39 PM   #15
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youbet, just so I don't cross too much with the "Socialized Medicine" thread, let's put that in the context of this wheelchair.

So let's say you and I qualify for and choose a higher deductible plan and 20% copay with a max (trading those moderate out-of-pocket bills for more upscale coverage for other items for example). If we need a wheelchair, we want the most for our money. The ins company would want to help us find a good deal (maybe get us their near-wholesale prices), so that we don't use up our deductibles so quickly and tap into *their* dollars.

For someone with the most basic coverage, the ins is certainly going to want to control costs. They might buy the $90 wheelchair for you, and offer you $20 for it if you return it later in good condition. They could refurb it and re-use it.

Just like the "invisible hand" it seems there would be millions of ways to gain efficiencies. Millions of ways to skimp also, but competition should control that. Transparency and "customer reviews" should help there.

I'm guessing your concerns are more in the "but the Devil's in the details" area. I agree. It is unlikely that the govt would propose anything like samclems outline at all. It just makes too much sense.

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Old 03-05-2009, 02:06 PM   #16
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It is a fallacy to insist that the private sector will necessarily yield the optimal result.
Blue Cross / Blue Shield insisted on renting one of those $90.00 wheelchairs for me at $165 per month for 5 months. I think the inefficiencies derive from beaurocracy and cronyism.
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Old 03-05-2009, 03:02 PM   #17
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It is a fallacy to insist that the private sector will necessarily yield the optimal result.
Blue Cross / Blue Shield insisted on renting one of those $90.00 wheelchairs for me at $165 per month for 5 months. I think the inefficiencies derive from beaurocracy and cronyism.
...at $165/month vs $237/month a case could be made for the private sector being 43% more efficient than the public sector.
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Old 03-05-2009, 04:41 PM   #18
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I've noticed a lot of these electric wheelchairs for sale on Craigslist and wonder if Medicare routinely buys them for people not far from death and the family in turn sells the wheelchair when it is no longer needed.

I seriously doubt that the average recipient ever actually wears one out.
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Old 03-05-2009, 04:43 PM   #19
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It is a fallacy to insist that the private sector will necessarily yield the optimal result.
Blue Cross / Blue Shield insisted on renting one of those $90.00 wheelchairs for me at $165 per month for 5 months. I think the inefficiencies derive from beaurocracy and cronyism.
As Westernskies says, it is an improvement....

But I wonder - if you called BCBS and asked for an explanation, would it be any better than what the Medicare people gave.

Since I got a high deductible BCBS policy for my son, I'm kinda curious myself.

-ERD50
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Old 03-05-2009, 05:05 PM   #20
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Before I took over my Mother's finances she got a wheel chair (probably through Medicare) that was a POS. It is my observation that we could hardly give it away when it was evident that it couldn't meet her needs.

Hey, lets set up a "Goodwill" for medical equipment such as wheel chairs and motor chairs and incent insurers such as Medicare to use that resource. People with disabilities could repair and clean them up after they don't meet the needs of the former user.

If a patient wants only new then offer them the same amount as the "Goodwill" receives for used.

There are some patients with very special needs for whom this wouldn't be appropriate but that would be evident from the other medical services they are receiving.
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