Saturday, October 9, 2010

Los Angeles Medical Equipment Supplier Sentenced to 46 Months in Prison for Role in Billing Power Wheelchairs to Medicare

Another sentence has been imposed in the power wheelchair Medicare fraud cases. On October 4, 2010, Sylvester Ijewere, 49,  the owner and operator of Los Angeles durable medical equipment (DME) company Maydads Medical Supply, was sentenced to 46 months in prison by U.S. District Judge Dale S. Fischer of the Central District of California. Mr. Ijewere was also ordered to pay $211,755 in restitution. In addition, Mr. Ijewere was ordered to serve three years of supervised release following his prison term.

This sentence came after a guilty plea. Mr. Ijewere pleaded guilty on April 12, 2010, to health care fraud. Mr. Ijewere admitted that between June 2007 and October 2009, he conspired with others to purchase fraudulent prescriptions and medical documents which he used to submit false claims to Medicare for expensive, high-end power wheelchairs, and other DME.

Mr. Ijewere's company received approximately $4,000 in reimbursement payments for each power wheelchair claim he submitted to Medicare. Approximately 50 percent of the Medicare beneficiaries to whom Mr. Ijewere claimed Maydads had supplied power wheelchairs and other equipment lived more than 100 miles from Maydads’ Los Angeles-area offices in Central and Northern California. When patients are brought in from long distances it is a red flag to Medicare that there is patient marketing or fraudulent prescriptions. 

Mr. Ijewere admitted in his plea that he submitted or caused the submission of approximately $471,345 in false and fraudulent claims to Medicare through Maydads.

Mr. Ijewere’s alleged co-conspirator, Donna Wells, a patient recruiter, was charged for her role in the scheme in October 2009, and is scheduled to begin trial on November 9, 2010.

Attorney Comments:  In 1997, total billings to Medicare for power wheelchairs was $150 million. By 2003, this grew to $1.1 billion. The number has increased since 2003.  In addition, there was an OIG study indicating that sixty percent (60%) of all prescriptions for power wheelchairs did not meet documentation requirements imposed by Medicare. Many of the current federal and state investigations commence with documentation issues that are triggered when the physician who writes the prescription has seen the patient only one or two times and when the patient resides more than 30 miles from the DME or physician. 

In addition to documentation and medical necessity, there has been considerable concern raised about improper marketing of power wheelchairs. There were allegations that minority neighborhoods were targeted, using door-to-door solicitation, and that fully ambulatory older residents were offered kickbacks for participating and bounties for recruiting others. These individuals were then directed to specific physicians, some of whom also received kickbacks from the power wheelchair distributors. One factor contributing to the abuse was the large profit margin for suppliers of power wheelchairs. Medicare was paying more than $5,000 per power wheelchair claim in 2003, while the Veteran’s Administration paid closer to $3,000 per chair, which suggests that there was substantial profit in power wheelchairs reimbursed by Medicare.

The federal and state governments works on "projects."  The power wheelchair is a longstanding project by federal and state authorities. The first phase of prosecutions targeted those DMEs where wheelchairs were not delivered or where there was identity theft of Medicare beneficiaries. The second phase is for those DMEs where there was illegal marketing and a lack of medical necessity. I expect to see more prosecutions in the Central District of California over the next two years.

Posted by Tracy Green, Esq.
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