NATION Probes put brakes on wheelchair fraud

In many cases, claims were submitted for people who knew nothing about them.
WASHINGTON (AP) -- U.S. authorities have launched 50 investigations to stop unscrupulous power wheelchair suppliers from defrauding Medicare and causing anxiety to beneficiaries like 85-year-old Euralda Clodomar.
Phony claims seeking reimbursement for the expensive equipment have skyrocketed to the top of Medicare investigators' problems. The agency pays 80 percent of a chair's cost, and its share grew from $22.3 million in 1995 to $663.1 million in 2002, already surpassed this year.
In many cases, the beneficiaries, including Clodomar, had no knowledge that someone stole their Medicare identification numbers and submitted claims. Medicare investigators have identified $167 million in fraudulent claims in more than 20 states, they told The Associated Press.
One of those involved Clodomar, who lives in the Los Angeles area and testified against a wheelchair supplier in a federal courtroom there. After she walked unaided from the back of the room and mounted steps to the witness chair, the prosecutor asked jurors to notice that she didn't use a wheelchair.
Clodomar doesn't own a wheelchair, let alone the motorized model that was charged to Medicare at a cost of $3,840.
How bad this is
"It certainly is the fastest-growing scam in Medicare," said Dara Corrigan, acting inspector general in the Department of Health and Human Services.
"It's about a wheelchair that is very expensive and about people trying to make a profit."
The medical equipment industry has marketed its power wheelchairs aggressively, particularly in television ads targeting older people. The number of Medicare beneficiaries with at least one claim for a motorized wheelchair rose from about 55,000 in 1999 to 168,245 in the first nine months of this year.
Part of the increase can be explained by improvements that allow the wheelchairs to turn in a small radius. But an industry group, the Power Mobility Coalition, agrees that some claims result from fraud and is supporting the current government crackdown, "Operation Wheeler Dealer."
"If there is fraud, that hurts the good guys because it puts a black eye on everyone," said Steve Azia, a lawyer for the coalition.
So far, Medicare's crackdown has recovered $52.5 million. New suppliers have been banned temporarily from enrolling in the program, prosecutors have been ordered to bring cases quickly and officials are prepared to stop payments.
Medical personnel must certify that they have seen a patient before prescribing a motorized wheelchair.
Investigators are focusing on Florida, Texas, California and Louisiana. They're also pursuing potential fraud cases in New Jersey, Puerto Rico, New York, Pennsylvania, the District of Columbia, Alabama, South Carolina, Tennessee, Ohio, Michigan, Wisconsin, Oklahoma, Arkansas, Kansas, Montana, Idaho, Oregon and Arizona.
Extent of cases
Investigators say the cases can include:
UEquipment company suppliers who submit phony claims.
UDoctors who take kickbacks for writing prescriptions.
UPeople who roam shopping malls offering free medical equipment to anyone who'll sign up for a wheelchair.
UConspirators who stage fake deliveries, complete with pictures of patients who pose with their power chairs for a fee.
The part of the cost of a motorized wheelchair beyond Medicare's 80 percent often is covered by other insurance companies.
Some suppliers, investigators said, charged Medicare $5,000 or more for power wheelchairs but provided much cheaper motorized scooters.
Clodomar and other beneficiaries who testified in the Los Angeles case helped persuade a jury to convict Goodwill Sunday Edukere after just 30 minutes of deliberations.
Edukere had to return $249,000 and was sentenced to 33 months in prison.
Clodomar didn't know a claim had been submitted until federal agents came to see if she had a power wheelchair. She convinced them the same way she convinced jurors.
"I walked from the back of the house, where my room is, to the front," she said in an interview. "I said, 'I don't need one, thank God."'
Pressure sales
Elizabeth Bostick, 89, of Ocala, Fla., and her husband, who has since died, were approached by a saleswoman who represented medical equipment companies.
The parent firm billed Medicare $15,500 for two motorized wheelchairs, a hospital bed, a pressure mattress and other equipment for the couple, who said they needed none of it.
"They had too much pressure on me," said Bostick, who was surprised when two red, motorized scooters arrived. "I was wondering how it could have come. I thought a doctor had to give you one," she said.
Corrigan said fraudulent operators often try to scare the elderly.
"They'll say to the beneficiary, 'You may not need it now, but you know how Medicare is going. Medicare might be out of money in a few years,'" she said.