Fraud & Abuse

Scooter Store Sues CMS Alleging It Wrongfully Denied Valid Reimbursement Claims For Power Mobility Equipment

The Scooter Store is suing the Centers for Medicare and Medicaid Services (CMS) alleging it wrongfully denied valid reimbursement claims for power mobility equipment provided to Medicare beneficiaries.

According to the complaint, the government should pay the claims because they include the congressionally-mandated Certificate of Medical Necessity signed by the patient's treating physician. The company said CMS contractors routinely ask for reams of other information not required under existing law.

"We have followed the law and physicians' orders, and government contractors seem to keep creating reasons to deny claims. As our complaint shows, even officials within CMS have admitted that they have violated the law as a result of their effort to drive down utilization of the power mobility benefit," said The Scooter Store President Mike Pfister.

Meanwhile, the company also has filed a motion to dismiss counterclaims brought against it by the Department of Justice on behalf of CMS in a separate action contending that The Scooter Store violated the False Claims Act.

The counterclaims, the company's dismissal motion argues, offer "conclusory allegations or legal conclusions masquerading as factual conclusions."

"[T]he arguments made by the government actually prove that [The Scooter Store] has acted lawfully and in the best interest of Medicare beneficiaries, because the government admits that all of our claims were submitted based upon the certified conclusions reached by treating physicians," said Pfister.

To read The Scooter Store's press release, go to http://www.thescooterstore.com/news/pr_20050601.aspx?refloc=mainb