TV ads show smiling seniors enjoying
an "active" lifestyle on a motorized scooter, taking in the sights at
the Grand Canyon, fishing on a pier and high-fiving their grandchildren
at a baseball game.
The commercials, which promise
freedom and independence to people with limited mobility, have driven
the nearly $1 billion U.S. market for power wheelchairs and scooters. But the spots by the industry's two leading companies, The Scooter Store
and Hoveround, also have drawn scrutiny from doctors and lawmakers, who
say they create the false impression that scooters are a convenient
means of transportation rather than a medical necessity.
Members of Congress say the ads lead to hundreds of millions of dollars in unnecessary spending by Medicare,
which is only supposed to pay for scooters when seniors are unable to
use a cane, walker or regular wheelchair. Government inspectors say up
to 80 percent of the scooters and power wheelchairs Medicare buys go to
people who don't meet the requirements. And doctors say more than money
is at stake: Seniors who use scooters unnecessarily can become
sedentary, which can exacerbate obesity and other disorders.
"Patients have been brainwashed by The Scooter Store," says Dr.
Barbara Messinger-Rapport, director of geriatric medicine at the
Cleveland Clinic. "What they're implying is that you can use these
scooters to leave the house, to socialize, to get to bingo."
The scooter controversy, which has escalated with a government raid
on The Scooter's Store's New Braunfels, Texas, headquarters last month,
underscores the influence TV ads can have on medical decisions. Like
their peers in the drug industry, scooter companies say
direct-to-consumer advertising educates patients about their medical
options. But critics argue that the scooter spots are little more than
sales pitches that cause patients to pressure doctors to prescribe
unnecessary equipment.
The Scooter Store and Hoveround, both privately held companies that
together make up about 70 percent of the U.S. market for scooters, spent
more than $180 million on TV, radio and print advertising in 2011, up
20 percent since 2008, according to advertising tracker Kantar Media.
Their ads often include language that the scooters can be paid for by
Medicare or other insurance: "Nine out of ten people got them for little
or no cost," states one Hoveround ad.
Hoveround did not respond to a half-dozen requests for comment. The
Scooter Store, the nation's biggest seller of scooters, said that most
people who contact the company after seeing the ads do not ultimately
receive a scooter.
"The fact that 87 percent of the persons who seek power mobility
products from The Scooter Store under their Medicare benefits are
disqualified by the company's screening process is powerful evidence of
the company's commitment to ensuring that only legitimate claims are
submitted to Medicare," the company said in a statement. The Scooter
Store has been operating with a streamlined staff in recent days,
following massive layoffs in the wake of the raid by federal agents.
Insurance executives say doctors who don't understand when Medicare
is supposed to pay for scooters are partly to blame for unnecessary
purchases.
Scooters — which are larger than power wheelchairs and often include a
handlebar for steering — are covered by Medicare if they are prescribed
by a doctor who has completed an evaluation showing that their patient
is unable to function at home without a device.
The doctor fills out a lengthy prescription form and sends it to a
scooter supplier that delivers the device to the patient and then
submits the paperwork to Medicare for payment. Medicare pays about 80
percent of that cost, which can range from $1,500 to $3,500. The
remainder is often picked up by supplemental insurance or the
government-funded Medicaid program for low-income and disabled
Americans.
The process can help immobile seniors get equipment that improves
their lives. Ernest Tornabell of Boynton Beach, Fla., received a scooter
from Pride, a smaller manufacturer, through Medicare about six years
ago. The 73-year-old suffers from obesity, diabetes and lung disease and
says he used to never leave his house. Now, using the scooter he can
walk his dog, go to the grocery store and run other errands.
"I couldn't really get out and do anything before. Now I have a lot
more mobility," said Tornabell, whose doctor recommended that he get the
device.
But Dr. Stephen Peake, medical director for the insurer Blue Cross
Blue Shield in Tennessee, says doctors can often be as uninformed about
the appropriate role of scooters as patients.
"I talk to a lot of physicians about this subject ... and after our
discussions, they don't understand that you can't get a power mobility
device so mom can go to the park with the family," Peake said in
testimony before the Senate Committee on Aging last year.
One reason for the confusion? Doctors say scooter companies are just
as aggressive with health professionals as they are in marketing to
their patients.
Dr. Jerome Epplin of Litchfield, Ill., who also testified before the
Senate, estimates that only about one out of every 10 patients who ask
him for a scooter actually needs one. But he said that sales
representatives from some scooter companies put pressure on him by
accompanying patients to his office. The effect is coercive, he says.
"It can be intimidating," Epplin says. "I see it as an inappropriate
attempt to influence my clinical judgment when I'm evaluating a
patient."
Allegations of Medicare fraud within the industry go back nearly a decade.
In 2005 the U.S. Justice Department sued The Scooter Store, alleging that its advertising enticed seniors to obtain power scooters
paid for by Medicare, and then sold patients more expensive scooters
that they did not want or need. The Scooter Store settled that case in
2007 for $4 million.
As part of the settlement, The Scooter Store was operating under an
agreement that made the company subject to periodic government reviews
between 2007 and last year. In 2011, the latest review available,
government auditors estimated that The Scooter Store received between
$47 million and $88 million in improper payments for scooters.
The Scooter Store took no action to repay the money until February
2012, when the Health and Human Services' inspector general threatened
to bar the company from doing business with Medicare, which accounts for
about 75 percent of its income, according to its congressional
testimony.
The company said the government's estimate was flawed and that it was
willing to repay $19.5 million in overpayments. The company has paid
about $5.7 million, with the rest scheduled for repayment over a 5-year
period to be completed in 2017.
Medicare said in a January letter that it accepted the fee based on
The Scooter Store's own assessment of what it owed, but that the
agreement "does not absolve The Scooter Store from any further
liability."
In recent months Sen. Richard Blumenthal,
D-Conn. and other members of the Senate Aging Committee have pushed
Medicare to recover the millions of dollars spent on unnecessary
scooters each year. Those purchases totaled about $500 million in 2011,
the latest year available, according to a report by the Department of
Health and Human Services' inspector general.
Medicare, which says that it does not have control over how companies
market chairs, launched a pilot program designed to reduce wasteful
spending on scooters.
Under the program, government contractors in seven states review
patients' medical documentation to make sure they need a wheelchair or
scooter before approving payments for a device. The program is being
tested in a small number of states — including Florida, California and
New York — because the government must pay contractors extra to review
additional paperwork.
The program has been criticized by The Scooter Store's executives,
who say that contractors are too strict in their reviews, rejecting
payments for power chairs that are genuinely needed.
The reduced payments are taking a toll on the company, which was
founded in 1991. The Scooter Store has spent nearly $1 million lobbying
Congress over the last two years, almost exclusively focused on the
Medicare review program. And the company laid off about 370 employees in
the past year, blaming the reduced payments it's been getting from
Medicare.
Then, last week, The Scooter Store notified most of its remaining
1,800 employees that their jobs were being eliminated. The company said
in a statement to the Associated Press that it is operating with a
workforce of 300 employees — down from the 2,500 workforce it had at its
peak — while trying to restructure its operations.
The mass layoffs followed a raid in February by about 150 agents from
the FBI, the Department of Justice and the Texas attorney general's
Medicaid fraud unit at the company's headquarters.
Federal authorities have declined to speak about the raid, but scooter industry critics in Congress praised the action.
"This raid is a welcome step toward cracking down on waste and fraud
in Medicare," said Blumenthal, the Connecticut senator. "I have urged
action to stop abusive overpayments for such devices — costing taxpayers
hundreds of millions of dollars and preying on seniors with deceptive
sales pitches."
I
have a 50-year-old box of vanilla extract that I keep around for the
novelty and the vintage package design. I don't know what the bottle
looks like because I've never opened the box. But that vanilla is
downright fresh compared to some unearthed foodstuffs studied by
archaeologists. Can you imagine a bowl of soup 2,400 years old? 
There
may be as few as 400 Ploughshare Tortoises in the world. Police in
Thailand caught a man trying to sneak out of the country with 54 of them
and other rare tortoises in his luggage:
