Orbit Medical: Altered Wheelchair Prescriptions and the Joint Settlement

In the Orbit Medical fraud settlement, Orbit Medical and its partial successor, Rehab Medical, agreed to pay $7.5 million to resolve allegations that sales representatives altered physician prescriptions and supporting records to get power wheelchairs and accessories paid for by federal healthcare programs. The alleged changes reached nearly every part of the file: the examination date, the medical justification, the physician’s signature and even the fax markings that made a document appear to have come from a doctor’s office.

The Justice Department announced the settlement on May 27, 2015. Orbit was a durable medical equipment supplier based in Salt Lake City, Utah. Its case shows why the original physician record matters to someone inside a supplier: a file can look ready for payment because the sales force allegedly rewrote the evidence it needed.

What Orbit Medical Allegedly Changed

The government alleged five methods of falsifying the wheelchair file. Together, they addressed when the patient was examined, whether the equipment was medically necessary, who signed the paperwork and where the supporting documents appeared to originate.

Dates That Made the Prescription Look Timely

The prescription had to reach the supplier within 45 days of the physician’s face-to-face examination under the requirements described in the settlement announcement. The government alleged that Orbit representatives changed or added dates to prescriptions and chart notes to make that deadline appear satisfied.

The dates connected the examination to the order. Changing them could make a late prescription look timely on the face of the file. A billing employee looking only at the final version would see a different sequence from the one documented by the physician’s original records.

Medical Need Added to the Prescription and the Chart

The government separately alleged that sales representatives changed physician prescriptions to falsely establish medical necessity for a power wheelchair or accessory. It also alleged that they created or altered chart notes and other supporting documents for the same purpose.

The prescription says what the physician ordered. The chart supports why the patient needs it. Orbit’s sales representatives allegedly changed both the instruction and its justification. Altering the supporting notes could make an altered prescription appear consistent with the clinical record.

Accessories were part of the allegation too. The claimed medical need could concern an addition to the wheelchair as well as the chair itself. That matters to an employee who recognizes the base equipment but sees a different accessory or justification in the file used for billing.

Signatures and Fax Markings That Made the File Look Authentic

The government alleged that representatives forged physician signatures on prescriptions and chart notes. It also alleged that they added facsimile stamps to supporting documents to make them appear to have been sent by the physician’s office.

The fax stamp is a particularly revealing detail. It addressed the apparent origin of the document, beyond what the document said. A supplier-created record could arrive in the billing file dressed as a record received from the clinic. Under that allegation, the evidence of medical need and the evidence of who supplied it were both manufactured.

Why Power Wheelchair Records Mattered

Medicare’s power-wheelchair benefit depended on the patient’s ability to function at home. The settlement announcement explained that Medicare paid for beneficiaries who could not perform activities of daily living using other mobility assistance, such as a cane, walker or power scooter. The physician’s examination and supporting records were how the supplier documented the need for the device it wanted paid.

The prescription described in that announcement had to come from the physician who performed the examination. It had to identify the beneficiary, the examination date, the diagnoses and conditions the wheelchair would accommodate, the length of need and the physician’s signature. The alleged alterations targeted the very information that connected a sale to a medical decision.

For specified complex power-wheelchair categories, the later Medicare power-mobility coverage policy requires a specialty evaluation by a qualified clinician with no financial relationship to the supplier. It also requires direct, in-person involvement in wheelchair selection by a certified assistive technology professional employed by the supplier.

The policy permits a supplier to provide a template for the written order before delivery, but forbids the supplier from filling in its elements.

The paperwork requirements have changed since Orbit’s case. Effective January 1, 2020, the Centers for Medicare & Medicaid Services replaced the former power-mobility order requirements with a six-element standard written order and a face-to-face encounter within the preceding six months. The historical deadline explains Orbit’s date-change allegation. The continuing question is who created the clinical content used to support payment.

The Sales Operation and the Federal Payers

Orbit’s sales representatives allegedly changed the records to obtain federal health care payments from Medicare, the Federal Employees Health Benefits Plan and the Defense Health Agency.

The government’s intervention announcement alleged that the representatives acted at the direction and encouragement of Orbit’s former vice president and Western-region sales manager.

For someone in sales, intake or billing, that is a recognizable conflict: the business seeking payment also handles the records meant to justify it. In Orbit’s case, the government alleged that sales staff used that access to change what appeared to be the physician’s work. Taxpayers were paying for wheelchairs that, according to the government, physicians had not legitimately prescribed.

Rehab Medical, the Joint Settlement and the Whistleblower Reward

Rehab Medical joined Orbit in the corporate settlement as a partial successor. The Justice Department identified Rehab as an Indianapolis, Indiana durable medical equipment supplier and described the alleged prescription changes as the work of Orbit’s sales representatives. The joint payment resolved those allegations against the companies.

Two former Orbit employees brought the False Claims Act case. The government joined the case.

The settlement announcement said the former employees would receive approximately $1.5 million jointly as their whistleblower reward. Their knowledge from inside the supplier brought the alleged document changes into a case over federal payments.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

Sales-Driven Paperwork in Other Wheelchair Cases

In a separate whistleblower complaint against Numotion, the whistleblowers alleged that supplier staff filled out medical evaluation forms before therapists evaluated patients and then presented the forms to clinicians for signature.

Supplier Changed Physician Wheelchair Order After Signature

When a supplier changes a signed wheelchair order, the versions matter. The physician’s original prescription, the version used to support the claim and the accompanying chart notes can show what changed between the medical decision and the request for payment.

Different employees may see different parts of that sequence. Someone receiving prescriptions may know what arrived from the clinic. A sales employee may know who requested a change. A billing employee may know which version went into the claim file.

You Saw the Order Before It Changed

If you saw wheelchair prescriptions, chart notes or fax markings changed to secure payment, speak to one of our whistleblower experts about how the orders were changed. We build your strongest case with you, bring in durable medical equipment fraud whistleblower lawyers who understand the physician-order and billing chain, and stay beside you as the case moves forward.