Rest Assure Home Medical Equipment: A Cheaper Scooter Behind a Wheelchair Claim

The Rest Assure Home Medical Equipment fraud case involved wheelchair upcoding: the owner billed Medicare for more expensive wheelchairs while supplying cheaper scooters or lower-priced wheelchairs, according to the Justice Department’s account of her guilty plea. The customer received equipment. The fraud was in the difference between that equipment and the product Medicare paid for, a difference someone handling the chairs, deliveries or billing could recognize.

Rest Assure operated in Rayne, Louisiana, supplying power wheelchairs and scooters to Medicare beneficiaries. The health care fraud case concerned billing from August 2007 through April 2009. In its January 18, 2013 announcement, the Justice Department described the former owner and president’s admission that she had submitted false claims and received Medicare reimbursements she was not entitled to collect.

Power Wheelchair Billed, Cheaper Scooter Actually Delivered

In Rest Assure’s criminal case, the guilty-plea documents described both a product that Medicare would not reimburse and a product that Medicare would reimburse at a lower rate.

The scooters supplied to customers were not reimbursable by Medicare, according to the Justice Department. The less expensive wheelchairs were reimbursable, but for less than the wheelchair the owner billed. Medicare paid wheelchair prices for scooters it would not have paid for at all.

That distinction matters inside a supplier. A delivery employee could truthfully say that equipment reached the customer, while the billing still described a different product.

Why the Product Category Changes the Medicare Claim

The Centers for Medicare & Medicaid Services identifies power-operated vehicles and power wheelchairs within its power mobility benefit. The industry’s coding categories distinguish scooters, power wheelchair bases, manual wheelchair bases, seating systems, cushions and accessories.

What Evidence Is Needed to Report Medicare Fraud?

For wheelchair upcoding, billing records, product information and delivery records can show whether the equipment supplied matches the wheelchair claimed. The decisions behind a substitution matter too. We work with insiders to connect what the supplier billed, what left the warehouse and who directed the substitution.

A Wheelchair Still on the Warehouse Shelf

In a separate complaint against Numotion, a former employee alleged that an operations manager’s report identified 263 orders for wheelchairs and wheelchair parts that Medicare had paid for but that had not been delivered. The complaint described where the equipment was:

Medical Paperwork Changed to Support the Chair

In Orbit Medical‘s case, the government alleged that sales representatives altered prescriptions and chart notes to make power wheelchairs or accessories appear medically necessary. The government also alleged that staff forged physician signatures and added fax stamps to make documents appear to come from the physician’s office.

Different False Claims Leave Different Traces

Upcoding, non-delivery and unsupported medical necessity concern different breaks between a claim and the care or equipment behind it. A warehouse record speaks to delivery. Product information speaks to what was supplied. The clinical file speaks to the medical basis for the order.

An insider may know that part of the business in detail without seeing every claim. Our work starts with that knowledge: what the product was, how the paperwork described it and who made the decisions connecting the two.

For insiders considering a civil case, a whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Which Chair Left the Warehouse

If the wheelchair on the claim differs from the equipment that actually went out, your knowledge of the products, payments and decisions can expose the mismatch. We stay with you through the case, bringing in Medicare fraud whistleblower lawyers who understand equipment billing. Speak with our whistleblower experts about building your strongest Medicare durable medical equipment whistleblower case.