Physician Was Hub in Power Wheelchair Racket, Feds Say

June 09, 2014

There's an axiom that the single biggest driver of healthcare spending is the physician's pen, or to be up to date, the physician's mouse and keyboard. Laboratory tests, diagnostic imaging, prescription drugs, hospitalization, home healthcare, and durable medical equipment (DME) such as power wheelchairs — a physician signs off on all of them.

And sometimes not honestly.

That is the accusation facing 67-year-old Robert Glazer, MD, from Los Angeles, California, who was recently indicted in a federal district court on healthcare fraud charges. In exchange for kickbacks, said prosecutors, Dr. Glazer wrote medically unnecessary prescriptions for power wheelchairs and certifications for home care. Fraudulent claims submitted by DME and home healthcare companies, plus those submitted by Dr. Glazer for his often fictitious services, added up to $33 million from January 2006 to May 2014, according to prosecutors. Medicare paid roughly $22 million on those claims.

Power wheelchairs have been a flourishing racket for fraudsters, partly because of their wide profit margin. DME companies can buy the chairs wholesale for $900 apiece and then bill Medicare for roughly $6000, according to the US Department of Justice (DOJ).

Medicare will pay for power wheelchairs if beneficiaries have mobility issues that hinder them in household activities such as bathing, dressing, and using the toilet, but only if less expensive equipment such as a walker or a regular wheelchair cannot solve their problem. It is a solution of last resort, and not only for financial reasons: Ordering an unneeded power wheelchair can harm a patient, because he or she may become dependent on it, leading to physical atrophy, according to the government.

One smoking gun statistic is that in the first half of 2007, 9% of power wheelchairs provided to Medicare patients were medically unnecessary, whereas another 52% were based on claims with insufficient documentation to determine necessity, according to a 2011 report from the Office of Inspector General for the US Department of Health and Human Services. The government has warned beneficiaries about offers of free or dirt-cheap power wheelchairs and about advice to get a chair now for future use before Medicare runs out of money. DME companies often make good on the promise of a free chair by waiving the Medicare beneficiary's 20% copayment, which is illegal.

Another illegal practice by DME companies is giving kickbacks to patient recruiters or "marketers." Such individuals, according to the government, may approach an elderly person on the street or in a supermarket and encourage them to get a free power wheelchair. In Dr. Glazer's case, marketers operating throughout Southern California also enticed patients with gifts ranging from a kitchen blender to rice and beans, according to court records.

Both DME company owners and physicians in their networks have been routinely convicted in federal court in recent years for attempting to get rich through power wheelchair schemes. Meanwhile, many of the chairs sit unused in garages, closets, and living rooms, collecting dust or holding up television sets.

Power Wheelchair Surprise

According to an affidavit from the Federal Bureau of Investigation (FBI), Dr. Glazer was a heavy prescriber of power wheelchairs. From January 2006 through April 2014, he ordered, on average, 134 chairs per year. The affidavit called this figure a "serious indicator of fraud," noting that physicians with a geriatric caseload may prescribe only 1 or 2 a year.

Dr. Glazer ordered power wheelchairs for beneficiaries who did not want or need them, according to the FBI. They included a woman who walked each day for 30 minutes and another who lived on the second floor of an apartment with no elevator and who ran errands by herself, using a cane, the FBI agent notes. Sometimes beneficiaries did not know that Dr. Glazer had ordered a chair, which showed up at their door unexpectedly. In other instances, an expected wheelchair never materialized.

For Dr. Glazer, it was easy money, according to the government. One DME company that filled Dr. Glazer's prescriptions for power wheelchairs paid kickbacks ranging from $200 to $1000, the DOJ stated in a separate criminal prosecution. In that case, the company president was convicted of Medicare fraud and sentenced to14 months in prison.

Some of Dr. Glazer's kickbacks came from a combination DME and home healthcare company very close at hand, the DOJ said. The company was co-owned by his office manager.

Home Healthcare Patients Drove Cars and Exercised, Feds Say

The FBI affidavit lays out a similar set of allegations about Dr. Glazer's certifications for home healthcare. The patients often were anything but homebound — driving cars to medical appointments, attending church, and exercising.

Dr. Glazer usually ordered 8 to 10 weeks of home healthcare, with nurse visits once or twice a week. However, a nurse made it out to the patient's home only about 3 times altogether, even though the home healthcare company would bill Medicare for more, according to the affidavit. In some cases, patients told the visiting nurse after several visits not to return — what was the point, after all?

Medically unnecessary certifications for hospice care also were part of the scheme, said prosecutors.

Then there were Dr. Glazer's own Medicare claims for medically unnecessary services, many of which were never performed, according to the government. A number of patients told the FBI that they did not undergo the electrocardiograms, ultrasounds, allergy shots, ear wax removal, and other services that Dr. Glazer billed Medicare for.

He was arrested on fraud charges on May 13, roughly 4 months after he was indicted by a federal grand jury and 1 day after a criminal complaint was filed in the district court in Los Angeles. The grand jury indictment was formally filed on June 3.

Dr. Glazer had yet to enter a plea of either guilty or not guilty as of June 6. His lawyer of record, William L. O'Bryan, did not respond to requests for an interview.

Dr. Glazer earned his medical degree in 1975 from the Universidad Autonoma de Guadalajara School of Medicine in Mexico, according to the Medical Board of California. In March 2012, the board issued a public letter of reprimand to Dr. Glazer after it determined that he "failed to properly manage [a] patient's complaint of dizziness, memory loss, and the prescribing of methotrexate, and failed to adequately obtain a complete history and physical examination of a patient with chronic pain."

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