Posted: Oct 20, 2011 11:49 AM
Updated: Jun 28, 2012 10:21 AM
WESLACO - Some Valley seniors are being targeted by medical equipment companies.
Durable medical equipment companies provide items like wheelchairs, walkers, and scooters to senior citizens. Irma Gonzalez says crooked DME companies are getting senior citizens unneeded power chairs. Gonzalez is the office manager at Dr. Raul Martinez's office in Edinburg.
She tells us power chairs are provided by Medicare and are intended for senior citizens who absolutely have no other way of getting around.
"Under the books and the guidelines, it specifically states they need to be bed-bound, bed-ridden. They're completely unable to walk," says the office manager.
But NEWSCHANNEL 5 met 72-year-old Maria Infante. She not only walks, but she also works in her yard and does other chores. Somewhere in Infante's home, underneath a pile of clothes, is an electric power chair. She tells us it's been sitting in the corner, since it was delivered almost a year ago. Infante tells us she couldn't even turn it on.
"The man who dropped it off, I told him that right now I don't need it," she says.
For now, Infante doesn't need an electric power chair. But if she ever needs another type of medical equipment, she's out of luck.
"Once they get a motorized wheelchair, Medicare will not allow any more benefits," explains Gonzalez. "If they need a walker or a cane, if they need a bedside commode, they will not qualify for any other equipment, because they have already been issued a power chair."
The medical office manager calls RGV Equipment Company "the biggest culprit." According to Gonzalez, the RGV DME LLC is able to order unneeded power chairs by bypassing Medicare rules. She tells us the company goes into an adult day care and gets seniors to sign up for a power chair. Her office has repeatedly denied requests for power chairs from RGV DME LLC.
Gonzalez tells us office workers even write in big letters that their patients do not need power chairs. Nonetheless, Gonzalez says the company continues to order power chairs and deliver them to patients who don't need them.
"Patients... are using them as coat racks at home. Patients... have small homes and are not equipped for power chairs," she explains. "You're talking about a 500-pound chair. These patients are elderly. They have no way to even move the chair."
"I have had clients that have been given a wheelchair that have Alzheimer's," says Ophelia Mungia, the director of the Rio Grande Adult Day Care. "How can you expect someone with Alzheimer's to work a wheelchair?"
NEWSCHANNEL 5 spoke to another Valley DME company to see how the chairs are being ordered without a doctor's consent.
Juan De Leon of United DME Inc. explains. "They're inputting the code as if they have a valid doctor's order. But since they don't have a valid doctor's order, they shouldn't be billing for the item in the first place. So that's where the fraud comes in," he says.
Medicare doesn't ask to see a signed doctor's form, so companies are able to get away with it. They only way Medicare can check the form is to physically go to a DME company and look at the patient's file themselves.
We spoke to a man who worked for RGV DME LLC. He doesn't want his identity known, because he still works in the medical industry. He tells us he quit the company, after he learned about their questionable practices.
The ex-employee tells us, "Once you get their medical card, you can bill anything you want to Medicare. And Medicare will pay for it and there is no justification for it."
"It was getting done automatically without any consideration of what the doctor has to say," he adds.
He said he knew what the company was doing was against the law. The whistleblower says the company was paying about $700 to $800 for unneeded power chairs. But they were getting reimbursed as much as $5,000 per power chair. He tells us 250 power chairs were given away in just three months.
"When I first got there, there was a generated report floating around. And the report says they had generated about $1.8 million in just the power chairs and fraudulent billing, before and while I was there," he says.
The ex-employee tells us, "I brought it up and nothing changed. And then I left."
NEWSCHANNEL 5 took what we learned to the RGV DME LLC to see what they had to say. The manager didn't want to see the tape we had. Fifteen minutes later, the company's owner arrived. He didn't allow our cameras in is office and refused to see his tape. He referred us to his attorney. The attorney didn't want to see the tape or talk to NEWSCHANNEL 5 either.
He said he'd get back to us on the matter.
NEWSCHANNEL 5 started working on this story months ago. It came to a halt, as we waited to hear from the federal government. Since then, we've learned the government is cracking down on DME companies. DME companies will be required to become accredited by the federal government by next September. That means all companies will have to abide by much stricter guidelines in order to do business.
Until then, some DME companies will likely continue to take advantage of the Medicare system and the elderly. NEWSCHANNEL 5 spoke with a spokesperson for the Centers for Medicare and Medicaid Services. While he couldn't speak about specific cases possibly under investigation in the Valley, he said the Valley is a hotbed for Medicare fraud.
If you're aware of any kind of Medicaid fraud, we'd like to hear about it. You can e-mail firstname.lastname@example.org.