Calls for Further Reform to Address Medicare Waste, Fraud and Abuse
Jul 07 2011
WASHINGTON – Today, Sen. Tom Carper (D-Del.), Chairman of the Subcommittee on Federal Financial Management, expressed concern regarding a Department of Health and Human Services (HHS) Office of the Inspector General (OIG) report that detailed millions of dollars in improper payments made by the Centers for Medicare and Medicaid (CMS) for power wheelchairs for Medicare beneficiaries. The report, Most Power Wheelchairs in the Medicare Program Did Not Meet Medical Necessity Guidelines (OEI-04-09-00260), found that over the first six months of 2007 sixty-one percent of the Medicare approved claims for power wheelchairs were "medically unnecessary" or lacked sufficient documentation to allow for the payments. Of the $189 million in paid power wheelchair claims for the six month period, $95 million did not meet the set standards required for payment.
"The Inspector General raises some troubling questions and shows all too clearly that while the federal government has made some progress in preventing waste and fraud, much more remains to be done," said Sen. Carper. "Everything that I do, I know I can do better. 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. 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."
Power wheelchairs are among the most expensive durable medical equipment covered by Medicare with costs ranging from $4,000 to $11,000, according to the HHS Inspector General report. Payments are made by the federal government to medical equipment providers, based on prescriptions and diagnoses by medical doctors. In 2009, Medicare Part B spent approximately $8.1 billion on durable medical equipment (DME), prosthetics, orthotics, and related supplies for 10.6 million beneficiaries. In 2010, the HHS Inspector General testified before Congress that for the past three decades, the Office of the Inspector General has identified significant levels of fraud and abuse related to durable medical equipment, including power wheelchairs.
Last month, Sens. Carper and Coburn, in addition to a bipartisan group of six senators, introduced legislation to curb waste and fraud in Medicare and Medicaid. The Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers Dollars Act (S.1251), or the "FAST Act," includes a provision specifically requiring increased screening of Medicare providers. It also requires pre-payment screening of all power wheelchairs and other durable medical equipment susceptible to fraud.
Sen. Carper's Subcommittee on Federal Financial Management will examine the issue of Medicare waste, fraud and abuse further on Tuesday, July 12th at 2:30pm in room 342 of the Dirksen Senate Office Building in Washington, D.C. Dr. Peter Budetti, the head of program integrity within the Centers for Medicare and Medicaid Services will appear as a witness, along with the Chief Counsel to the Inspector General, Mr. Lewis Morris.