Inside Health Reform: OIG Finds Wheelchair Overpayments: Lawmakers Urge Action, But DME Makers Downplay Findings
Jul 14 2011
Up to 61 percent of Medicare-funded power wheelchairs were medically unnecessary or lacked documentation to establish medical necessity, the HHS Office of Inspector General finds in a new report, equating to $95 million in just a six-month period in 2007, prompting outcry from key lawmakers. According to the OIG, 9 percent were declared unnecessary and 52 percent had insufficient documentation -- the latter statistic leading AA Homecare, a major durable medical equipment trade association that represents many wheelchair producers, to downplay the findings and suggest over-regulation may be largely to blame. The report nevertheless may put wheelchair manufacturers in the crosshairs of ongoing debt reduction talks aimed at cutting Medicare expenses.Sen. Charles Grassley (R-IA) told Inside Health Policy, "Given our challenging fiscal times, now more than ever, Medicare dollars need to be spent appropriately.
This report shows that CMS needs to improve oversight of power wheelchairs." And Sen. Tom Carper (D-DE) signaled the issue will likely come up in a Medicare fraud hearing his subcommittee on federal financial management plans to hold next Tuesday (July 12). Medicare beneficiaries who are prescribed power wheelchairs can purchase them from suppliers and bill the cost to Medicare Part B's durable medical equipment coverage. The OIG report was based on a medical record review of 375 randomly chosen claims for power wheelchairs provided to beneficiaries in the first half of 2007. The 61 percent accounted for $95 million of the $189 million in DME-allowed power wheelchairs. AA Homecare spokeswoman Alexandra Bennewith said her group will look into the OIG findings and respond -- but she emphatically downplayed its results. "Bear in mind that this data is from the first quarter of 2007, which is already four years old," she said, arguing that by 2007 providers had not had enough time to adjust to the coding changes CMS made to Medicare power wheelchair policy in 2005 and 2006. "We do not tolerate any kind of documentation that's not accurate or not submitted." Bennewith also pointed out that just nine of the 61 percent of Medicare-funded wheelchairs were decreed inappropriate by OIG, while the rest raised issues regarding documentation that she blamed on overregulation. "So to say 61 percent is a twisting of the report," she said. Bennewith said the real problem is that the paperwork process is too bureaucratic and needs to be simplified. She recommended reforms such as electronic prescribing of power wheelchairs and other DME products as well as improved training for physicians regarding what documentation needs to be submitted. "We need to look at documentation from both physicians and suppliers. The policy needs to be simplified so that all providers are able to provide the correct documentation.” But Carper called the report's findings "troubling" and said it was clear evidence that there's plenty of waste and fraud in Medicare. “When we see that more than half of Medicare's payments for power wheelchairs in a given time failed to meet the appropriate standards required for reimbursement, we know that something is very wrong and that the federal government can and must do better," he said in a statement. Carper has proposed to improve screening measures to reduce fraud for power wheelchair payments, and said he will renew his efforts in light of the OIG report. Carper said in a statement: "Bipartisan legislation that I introduced with Senator Coburn last month would address concerns raised by this Inspector General report by improving existing screening measures to better prevent fraud and abuse for power wheelchair payments, as well as other areas in Medicare and Medicaid. I will continue to work with my colleagues on both sides of the aisle and the Obama Administration to make sure we are taking the steps necessary to address this specific report's findings and address other areas of Medicare and Medicaid that remain vulnerable to waste, fraud and abuse." It remains to be seen whether the OIG report will spur further DME reforms in Congress, though CMS has promised to follow through on some of the OIG recommendations. Lawmakers from both parties, including House Ways and Means member Pete Stark (D-CA), have raised questions about Medicare overpayments for DME.The OIG calls for CMS to do the following: "(1) enhance reenrollment screening standards for current suppliers of durable medical equipment, prosthetics, orthotics, and supplies; (2) review records from sources in addition to the supplier, such as the prescribing physician, to determine whether power wheelchairs are medically necessary; (3) continue to educate power wheelchair suppliers and prescribing physicians to ensure compliance with clinical coverage criteria; and (4) review suppliers that submitted sampled claims we found to be in error.CMS told the OIG it disagreed with the reenrollment screening recommendation, but concurred with the other proposals. Medicare spent roughly $8.1 billion on power wheelchairs and other DME in 2009, according to a Government Accountability Office report issued late May. In 2010, the HHS Inspector General testified before Congress that for the past three decades the OIG has identified significant levels of fraud and abuse related to DME, including power wheelchairs. Two previous OIG reports based on the same sample of power wheelchairs found problems with coding and documentation requirements, and the new report shows additional problems with suppliers' compliance with Medicare requirements. "Across all three reports, 80 percent of claims for power wheelchairs supplied to Medicare beneficiaries in the first half of 2007 did not meet Medicare requirements," the new OIG report states. The OIG acknowledges that CMS has taken steps since 2007 to decrease errors among suppliers of power wheelchairs and other DME, but says the fact that Medicare has paid significantly more in recent years for power wheelchairs than it did in 2007 "may indicate that CMS continues to pay for power wheelchairs that are not medically necessary and/or have claims that do not meet documentation requirements."