Uncle Sam, The Scooter Sap

Over the weekend the Washington Post carried a terrific article about how fraudsters ripped off Medicare — and through Medicare, the American taxpayer — in the Great Scooter Scam.  It’s another troubling, cautionary tale that shows how good intentions can run awry, how fraudsters are always ready to pounce, and how our ponderous governmental apparatus is just not well-suited to ferreting out fraud.

The fraud scheme grew out of Medicare’s requirement that claims be paid promptly, and the vast scope of coverage that Medicare supplies.  With millions of claims being received, there was no way to check them out before making the required prompt processing decision.  So Medicare’s default approach was to pay claims first, investigate later.  The fraudsters learned this, and rubbed their hands with glee.  But fraudsters can’t perform surgery or other medical care, so how do they take advantage of that gaping vulnerability in the system?  Medical equipment was the answer . . . but the crooks then had to find just the right kind of equipment, where real money could be made.

Ultimately, they realized that scooters and motorized wheelchairs were perfect.  The need for them was plausible, and there was a huge gap between the actual cost of the devices and the inflated amount Medicare would pay.  The fraudsters created elaborate schemes that included “recruiters” who identified seniors to receive the scooters and bogus medical supply companies — and seniors who willingly participated because they thought there were getting a freebie, even if it was something that they didn’t need.  When Medicare changed the rules to require in-person doctor visits to try to stop the fraud, the crooks recruited doctors who were willing to participate in the fraud in exchange for a cut.

The result?  Perfectly able-bodied seniors with wheelchairs, still in their wrapping, gathering dust in their garages or serving as the perch for oversized teddy bears.  Seniors riffing on the Seinfeld episode and having scooter races in their neighborhoods.  And huge amounts of federal money lining the pockets of criminals.

The scope of the fraud is astonishing.  The Medicare system has paid billions for motorized wheelchairs, and they don’t even know how many of the purchases are legitimate.  One recent audit of paid bills showed that 80 percent were improper.  And even after the federal government became aware of the scooter scam, in 1998, it continued to pay billions in phony claims.  Since 1999, Medicare has paid $8.2 billion for 2.7 million motorized wheelchairs and scooters.  In 2003 alone, $964 million was spend on the devices.  These seem like huge numbers, but they are only a blip in the vast Medicare system — which is part of the reason why it took so long to meaningfully tackle the problem.

The Medicare system now says that it has effectively addressed the scooter scam, and the amounts spent on motorized wheelchairs fell to only $190 million in 2013.  Should we have confidence that all of that money — and all of the billions of dollars shelled out for other forms of medical equipment — is being spent in response to legitimate medical needs?  Not really.  The system is too large, oversight is minimal, and there are too many gaps where the fraudsters can take advantage.  And, perhaps most distressingly, there apparently are lots of “recruiters,” doctors, and seniors who apparently are all too willing to participate in a criminal scam so long as they get something out of it.

The Washington Post article about the Great Scooter Scam should be required reading for every Member of Congress who thinks the best way to solve a problem is to create a governmental program that pays out money to address it.

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