New Braunfels, Texas
In a continuing legal battle with the government, The Scooter Store has filed a new lawsuit — this time against CMS.
The May 27 complaint, similar to a lawsuit the company filed against the Department of Health and Human Services earlier this year, contends that CMS continues to deny TSS' power mobility equipment claims submitted with completed certificates of medical necessity and is violating the law by demanding additional documentation.
The suit includes comments from CMS Administrator Mark McClellan, given in a written statement during a hearing on his nomination last year, to support its case. McClellan is quoted as saying “the clinical criteria for deciding when a manual or power wheelchair is medically necessary and appropriate for a beneficiary has been and will continue to be a matter of clinical judgement by the physician.”
The lawsuit also accuses the Region D DMERC of illegally using diagnosis codes to suspend claims.
TSS contends that requiring documentation beyond a CMN for reimbursement of claims is in violation of the federal Paperwork Reduction Act, and the complaint alleges “that CMS contractors have demanded that TSS and other suppliers routinely and regularly supply them with volumes of information in addition to the CMN, in violation of HHS' own policies and the laws governing the Medicare program,” according to a company statement.
“The congressionally approved [CMN] was supposed to avoid confusion and bring integrity to the Medicare program. Unfortunately, CMS' present approach is having the opposite effect,” said TSS President Mike Pfister.
