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Scooter ads face scrutiny from government doctors

By Matthew Perrone

AP Health Writer

POSTED:
LAST UPDATED: 05:03 a.m. HST, Mar 28, 2013


WASHINGTON >> TV ads show smiling seniors enjoying an "active" lifestyle on a motorized scooter, taking in the sites at the Grand Canyon, fishing on a pier and high-fiving their grandchildren at a baseball game.

The commercials, which promise freedom and independence to people with limited mobility, have driven the nearly $1 billion U.S. market for power wheelchairs and scooters. But the spots by the industry's two leading companies, The Scooter Store and Hoveround, also have drawn scrutiny from doctors and lawmakers, who say they create the false impression that scooters are a convenient means of transportation rather than a medical necessity.

Members of Congress say the ads lead to hundreds of millions of dollars in unnecessary spending by Medicare, which is only supposed to pay for scooters when seniors are unable to use a cane, walker or regular wheelchair. Government inspectors say up to 80 percent of the scooters and power wheelchairs Medicare buys go to people who don't meet the requirements. And doctors say more than money is at stake: Seniors who use scooters unnecessarily can become sedentary, which can exacerbate obesity and other disorders.

"Patients have been brainwashed by the Scooter Store," says Dr. Barbara Messinger-Rapport, director of geriatric medicine at the Cleveland Clinic. "What they're implying is that you can use these scooters to leave the house, to socialize, to get to bingo."

The scooter controversy, which has escalated with a raid on The Scooter's Store's New Braunfels, Texas headquarters last month, underscores the influence TV ads can have on medical decisions. Like their peers in the drug industry, scooter companies say direct-to-consumer advertising educates patients about their medical options. But critics argue that the scooter spots are little more than sales pitches that cause patients to pressure doctors to prescribe unnecessary equipment.

The Scooter Store and Hoveround, both privately held companies that together make up about 70 percent of the U.S. market for scooters, spent more than $180 million on TV, radio and print advertising in 2011, up 20 percent since 2008, according to advertising tracker Kantar Media. Their ads often include language that the scooters can be paid for by Medicare or other insurance: "Nine out of ten people got them for little or no cost," states one Hoveround ad.

Hoveround did not respond to a half-dozen requests for comment. The Scooter Store, the nation's biggest seller of scooters, said that most people who contact the company after seeing the ads do not ultimately receive a scooter.

"The fact that 87 percent of the persons who seek power mobility products from the Scooter Store under their Medicare benefits are disqualified by the company's screening process is powerful evidence of the company's commitment to ensuring that only legitimate claims are submitted to Medicare," the company said in a statement.

Insurance executives say doctors who don't understand when Medicare is supposed to pay for scooters are partly to blame for unnecessary purchases.

Scooters — which are larger than power wheelchairs and often include a handlebar for steering — are covered by Medicare if they are prescribed by a doctor who has completed an evaluation showing that their patient is unable to function at home without a device.

The doctor fills out a lengthy prescription form and sends it to a scooter supplier that delivers the device to the patient and then submits the paperwork to Medicare for payment. Medicare pays about 80 percent of that cost, which can range from $1,500 to $3,500. The remainder is often picked up by supplemental insurance or the government-funded Medicaid program for low-income and disabled Americans.

The process can help immobile seniors get equipment that improves their lives. Ernest Tornabell of Boynton Beach, Fla., received a scooter from Pride, a smaller manufacturer, through Medicare about six years ago. The 73-year-old suffers from obesity, diabetes and lung disease and says he used to never leave his house. Now, using the scooter he can walk his dog, go to the grocery store and run other errands.

"I couldn't really get out and do anything before. Now I have a lot more mobility," said Tornabell, whose doctor recommended that he get the device.

But Dr. Stephen Peake, medical director for the insurer Blue Cross Blue Shield in Tennessee, says doctors can often be as uninformed about the appropriate role of scooters as patients.

"I talk to a lot of physicians about this subject ... and after our discussions, they don't understand that you can't get a power mobility device so mom can go to the park with the family," Peake said in testimony before the Senate Committee on Aging last year.

One reason for the confusion? Doctors say scooter companies are just as aggressive with health professionals as they are in marketing to their patients.

Dr. Jerome Epplin of Litchfield, Ill., who also testified before the Senate, estimates that only about one out of every 10 patients who ask him for a scooter actually needs one. But he said that sales representatives from some scooter companies put pressure on him by accompanying patients to his office. The effect is coercive, he says.

"It can be intimidating," Epplin says. "I see it as an inappropriate attempt to influence my clinical judgment when I'm evaluating a patient."

Allegations of Medicare fraud within the industry go back nearly a decade.

In 2005 the U.S. Justice Department sued The Scooter Store, alleging that its advertising enticed seniors to obtain power scooters paid for by Medicare, and then sold patients more expensive scooters that they did not want or need. The Scooter Store settled that case in 2007 for $4 million.

As part of the settlement, The Scooter Store was operating under an agreement that made the company subject to periodic government reviews between 2007 and last year. In 2011, the latest review available, government auditors estimated that The Scooter Store received between $47 million and $88 million in improper payments for scooters.

The Scooter Store took no action to repay the money until February 2012, when the Health and Human Services' inspector general threatened to bar the company from doing business with Medicare, which accounts for about 75 percent of its income, according to its congressional testimony.

The company said the government's estimate was flawed and that it was willing to repay $19.5 million in overpayments. The company has paid about $5.7 million, with the rest scheduled for repayment over a 5-year period to be completed in 2017.

Medicare said in a January letter that it accepted the fee based on the Scooter Store's own assessment of what it owed, but that the agreement "does not absolve the Scooter Store from any further liability."

In recent months Sen. Richard Blumenthal, D-Conn. and other members of the Senate Aging Committee have pushed Medicare to recover the millions of dollars spent on unnecessary scooters each year. Those purchases totaled about $500 million in 2011, the latest year available, according to a report by the Department of Health and Human Services' inspector general.

Medicare, which says that it does not have control over how companies market chairs, launched a pilot program designed to reduce wasteful spending on scooters.

Under the program, government contractors in seven states review patients' medical documentation to make sure they need a wheelchair or scooter before approving payments for a device. The program is being tested in a small number of states — including Florida, California and New York — because the government must pay contractors extra to review additional paperwork.

The program has been criticized by The Scooter Store's executives, who say that contractors are too strict in their reviews, rejecting payments for power chairs that are genuinely needed.

The reduced payments are taking a toll on the company, which was founded in 1991. The Scooter Store has spent nearly $1 million lobbying Congress over the last two years, almost exclusively focused on the Medicare review program. And the company laid off about 370 employees in the past year, blaming the reduced payments it's been getting from Medicare.

Then, last week, The Scooter Store notified most of its remaining 1,800 employees that their jobs were being eliminated. The company said in a statement to the Associated Press that it is operating with a workforce of 300 employees — down from the 2,500 workforce it had at its peak — while trying to restructure its operations.

The mass layoffs followed a raid in February by about 150 agents from the FBI, the Department of Justice and the Texas attorney general's Medicaid fraud unit searched the company's headquarters.

Federal authorities have declined to speak about the raid, but scooter industry critics in Congress praised the action.

"This raid is a welcome step toward cracking down on waste and fraud in Medicare," said Blumenthal, the Connecticut senator. "I have urged action to stop abusive overpayments for such devices — costing taxpayers hundreds of millions of dollars and preying on seniors with deceptive sales pitches."

____

AP writer Juan Lozano contributed to this report from Houston.







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serious wrote:
I wondered about those TV ads. Even the people used in the ads all look thin and healthy but one seldom sees a thin person ride one. Not sure the scooter came before or after the weight gain???
on March 28,2013 | 04:57AM
bender wrote:
I was wondering too. But my concern was that I had read of these scooter manfuacturer's being charged with Medicare fraud and I was wondering why they were still running basically the same advertisement as before. It was as if nothing had come from those fraud charges. The fact that Medicare accepts the Scooter Store's estimate of overpayment is also bothersome. There seems to be quite a disparity between what the Scooter Store says, $19.5 million and the $47 to 88 million that the government claims. But knowing government, they would spend $100 million to recover $31 million and the problem will continue.
on March 28,2013 | 05:44AM
soundofreason wrote:
Here's a kicker. I knew this lady that purchases one, thousands of dollars, she died within a week of receiving it and Medicare does absolutely nothing about retrieving these chairs, for others, when that happens.
on March 28,2013 | 06:13AM
cojef wrote:
Once funds are appropriated, it usual is spent without regard to whether the expenditure was necessary or is warranted. Witnessed "clean-out" of GSA store in LA, during the month of October, just before the close of the fiscal year. Navy pick-up trucks loaded with purchases, leaving the the store shelves bare. When we got there to replenish our supply of stationery items for our office, there was none left. Even our own office received instructions from higher level to replenish our stock by X number of dollars. Being a field office we did not have any idea what our allotment of funds were.
on March 28,2013 | 07:31AM
nitpikker wrote:
its about time!!! i never liked those scooter ads from the very first one!! they're saying the TAXPAYERS will pay for your scooter!! they should collect as much as they can get back from the scooter companies!! crook industry from the start!!
on March 28,2013 | 08:33AM
SueH wrote:
My mother was double amputee, so without legs or the possibility of prostheses, absolutely needed her scooter to get anywhere. She didn't use it to "cruise the mall" or visit the edge of the Grand Canyon, but simply to get around the house, including to the bathroom, the sink, and joining the rest of us at the dinner table. The scooter made her (and the rest of us in the family) more independent, and gave her a more positive outlook on life.
on March 28,2013 | 11:23AM
nodaddynotthebelt wrote:
So where do the doctors who approved of these scooters fall? They should be held accountable much the way they would be for issuing handicap placards to those who do not meet the requirements.
on March 28,2013 | 01:11PM
serious wrote:
Oh,I agree with you--I live in a no-dog condominium except for 'service dogs" approved by a Dr for that purpose--we have more dogs here than the dogs allowed condos. It's a fraud--yes, the doctors should show some responsibility!!
on March 28,2013 | 04:39PM
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