Medical providers who outfit patients with braces, orthotic shoes, electronic wheelchairs, and other devices are facing major Medicare audits.
Each week these provides, many of them small businesses, are receiving a list of 10 Medicare clients, and requests for major paperwork on each case. In each case the final bill has long since been paid.
The audits are being handled by contractors who make money on each case they find issue with, but the issues aren't of "medical necessity".
The contractors are searching for minute things, procedural issues such as if a doctor failed to date his signature even if the prescription was dated at the top, or if a date stamp is missing from the provider's fax machine.
There are legitimate cases of fraud within Medicare, but providers say this onslaught of needless paperwork is causing pain and suffering for the patient.
Peggy Murrah is a retired educator who spent more than 40 years in the education system. Four years ago she lost use of her legs. She says her power wheelchair is her legs, her lifeline to be able to go anywhere she wants.
Murrah's chair is a medical necessity, but Medicare disagrees.
"I cant' understand," Murrah said. "It blows my mind. It's essential I have this chair."
Murrah's case is one of millions in limbo due to Medicare audits executed in orthotists' offices across the nation.
"I have two claims right now that are pending..." a frustrated Cary Jinright explains, "that are more than $32,000." Jinright is the owner of Precision Medical Solutions and Murrah is one of his cases.
Jinright's company fitted Murrah for her chair back in 2010, but auditors recently filed a complaint saying the prescription Jinright provided for the chair was pre-printed, a claim Jinright strongly denies.
Jinright appealed the complaint, but the paperwork is massive. While he waits on a judge to make a decision in his case, he's required to pay interest on the case on a weekly basis. The wait time to see a judge now averages more than two years.
"It's not based on medical necessity," Jinright says. "That's my problem with it."
The audits have literally taken over the orthotist's practice and his office. It's now home to a makeshift filing system for cases in question instead of the medical equipment he needs.
But it's a necessity. Providers have 45 days to respond by mail or to fax the Medicare contractors. If they fail to do so, their funding will be pulled.
"I'm a small business owner," Jinright says. "I can't do that."
Murrah calls the entire experience "humiliating" and says she deserves to be "more than a line item in a budget". She spent 44 years teaching school, says she's paid her taxes and feels she's earned her chair and her healthcare.
But because of situations like Jinright's, the number of providers who will treat Murrah is rapidly shrinking. "I can't blame them," she says.
The red tape that's meant to stop Medicare fraud is also getting caught up in the wheels of Peggy Murrah's wheelchair, putting a halt to necessary healthcare in the process.
When reached for comment, a Medicare representative responding in writing to explain that the process is part of an effort to recoup losses on previous cases and to lower the error rate. The person said all "Bill for Fee" programs are subject to such audits.
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