WASHINGTON — 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 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 ads by the industry’s two leading companies, The Scooter Store and Hoveround, have drawn scrutiny from critics who say they convince some seniors that they need a scooter to get around when many don’t.
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 as a medical necessity 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 or don’t have the proper documentation for their claims.
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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 escalated with a raid by federal authorities on The Scooter’s Store’s New Braunfels, Texas, headquarters last month, illustrates the influence TV ads can have on medical decisions.
Scooter-company officials say direct-to-consumer advertising educates patients about their medical options. Critics say the scooter ads are little more than sales pitches that cause patients to pressure doctors to prescribe unnecessary equipment.
The Scooter Store and Hoveround, 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 from 2008, according to ad tracker Kantar Media. Their ads often include language that the scooters can be paid for by Medicare or other insurance.
Hoveround did not respond to requests for comment. Officials at The Scooter Store, the nation’s biggest seller of scooters, said most people who contact the company after seeing the ads do not 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, after 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 a 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. Tornabell, 73, is obese and has diabetes and lung disease and never used to leave his house. Now, using the scooter he can walk his dog, go to the supermarket 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 he get the device.
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 patients.
Dr. Jerome Epplin, of Litchfield, Ill., who also testified before the Senate, estimates that only one of every 10 patients who ask him for a scooter needs one. But he said 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.”
Accusations of Medicare fraud within the industry go back nearly a decade.
In 2005, the U.S. Justice Department sued The Scooter Store, saying its advertising enticed seniors to obtain power scooters paid for by Medicare, and the company 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 The Scooter Store received $47 million to $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 three-fourths of its revenue, according to its congressional testimony.
The company said the government’s estimate was flawed and it was willing to repay $19.5 million in overpayments. The company has paid about $5.7 million. The rest is scheduled for repayment by 2017.
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 it does not have control over how companies market the scooters, began 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 high-risk-for-fraud 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 needed.
The reduced payments are hurting the company founded in 1991. The Scooter Store has spent nearly $1 million lobbying Congress in the past two years, almost exclusively focused on the Medicare-review program. The company laid off about 370 employees in the past year, blaming reduced Medicare payments.
Last week, The Scooter Store notified most of its remaining 1,800 employees that their jobs were being eliminated.
The mass layoffs followed the raid in February by about 150 agents from the FBI, the Department of Justice and the Texas attorney general’s Medicaid fraud unit. Authorities searched the company’s headquarters.
Federal authorities 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.”
Associated Press writer Juan Lozano contributed to this report from Houston.