newjerseynewsroom.com

BY IRENE C. CARD and BETSY CHANDLER

NEWJERSEYNEWSROOM.COM

YOUR HEALTH INSURANCE

For Medicare to cover a power wheelchair or scooter, your doctor must state that you need it because of your medical condition. Medicare won't pay for a power wheelchair or scooter only for your convenience or for leisure activities.

It is interesting to note that Medicare specifically states, in their literature, that most dealers are honest but there are a few who aren't.

Medicare has become aware of an increasing amount of fraud in this industry. Some suppliers of this equipment try to cheat the program by offering power wheelchairs and scooters to people who don't meet Medicare's rules.

How does this fraud happen? It happens when the supplier of the equipment gives false or misleading information to you or to the Medicare program in order to get Medicare to pay for equipment that you might like to have but don't really need. Medicare fraud ends up costing all of us more money.

You can help by making sure you get the equipment that best fits your medical needs as determined by your doctor. You should also be aware of Medicare's guidelines for qualifying for power wheelchairs.

You qualify if you can't walk on your own and have severe upper body weakness because of a brain, spinal or muscle condition. You must have a health condition that makes you unable to walk on your own, be unable to operate a manual wheelchair, be able to safely operate the controls on a power wheelchair, and have a face-to-face exam and an order from the doctor treating you.

To qualify for a power-operated vehicle (or scooter), the rules are the same as those listed above for qualifying for a power operated wheelchair. In addition, you must be able to safely operate the controls of a power scooter and be able to safely get in and out of a scooter.

Your doctor must certify that you have a medical condition that requires this. Medicare will not pay for these two items if they are going to be used mainly for leisure or recreational activities. Or, if they are only needed to move around outside your home. Remember, you must have a medical need.

Assuming you meet the qualifications stated above, you have the choice of either renting or buying a power wheelchair or scooter. If you don't need this for long-term purposes, renting the equipment will reduce your out of pocket costs.

Because there is potential for fraud with this equipment, protect yourself from this by looking out for dealers who specialize in fraudulent tactics. Be aware of suppliers who offer you a free power wheelchair or scooter, suppliers who want you to use their doctors, or calls from companies you didn't give your phone number to.

If you do suspect fraud, call your doctor (or other health care provider), then call the Durable Medical Equipment Regional Carrier at 1-800-633-4227 and then call the Inspector General's hotline at 1-800-447-8477.

Irene Card & Betsy Chandler are both licensed insurance professionals working at MIC Insurance Services, a health insurance services company. If you have questions relative to this column or other related topics, call (973) 492-2828, or browse past columns on their Web site.