Power mobility is one of the most costly medical devices currently allowable under Medicare and Medicaid guidelines. However, for patients who truly need this type of assistance, the help of a power wheelchair means the difference between a full and active lifestyle versus a purely homebound existence. As such, Medicare guidelines set forth precise requirements for approval for a power wheelchair (detailed below).
In today’s case, we explore the details of a recent False Claims Act settlement involving two well-known power wheelchair companies accused of providing patients with power mobility devices despite a failure to certify some or all of the criteria for coverage.
The defendants, known as Orbit Medical, Inc. and Rehab Medical, Inc., will pay a combined $7.5 million to settle the claims, and have not admitted liability in the matter.
The case was brought to light by two former employees of Orbit Medical, who are expected to share a $1.5 million reward. Moreover, a separate but related case has yet to be resolved against the former vice president and manager of sales for Orbit. The government opted not to intervene in the lawsuits against the companies, but entered a complaint in intervention against the vice president individually.
Medicare guidelines & alleged misconduct
For Medicare enrollees, a power wheelchair may be a covered medical expense, provided certain criteria are met. The following details the requirements to lawfully prescribe a power mobility device without triggering possible False Claims Act liability:
- A doctor has certified that the patient has a medical need for scooter or power wheelchair use in the home;
- The patient has a medical condition that causes significant mobility issues;
- Daily living activities are impossible for the patient;
- The patient will be able to safely use the equipment, and has full-time help (from a family member or aide) to get on and off of the device safely;
- The prescribing physician is enrolled in Medicare;
- The device must fit through doorways and be useful from a practical standpoint.
In addition, a physician must conduct a face-to-face examination of the patient to determine whether a power wheelchair is necessary, and documentation of medical need must be submitted no later than 45 days from this meeting.
According to the allegations, both Orbit Medical and Rehab Medical knowingly altered the contents of physician prescription documents in order to get the most costly versions of the power wheelchair and accessories paid for by Medicare. Allegedly, many patients would have been served well by a less costly mobility option, such as a walker, but were provided the power wheelchair instead.
Moreover, the defendants’ employees are alleged to have intentionally changed physician orders to reflect a lapse of 45 days or less between the face-to-face meeting and the subsequent submission to Medicare. The Defendants are also alleged to have falsified documents to create the illusion of “medical need” for patients who did not otherwise qualify. Lastly, several documents are alleged to contain forged physician signatures and fake facsimile stamps to make it appear that the documentation was derived from the physician’s office.
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