Corporate Compliance

OIG examines improper Medicare wheelchair claims

Compliance Monitor, July 20, 2011

During the first half of 2007, Medicare spent $95 million on claims for power wheelchairs that were either medically unnecessary or lacked sufficient documentation to determine medical necessity.

The Office of Inspector General (OIG) report titled “Most Power Wheelchairs in the Medicare Program Did Not Meet Medical Necessity Guidelines”  also states that 61% of the power wheelchair claims provided to Medicare beneficiaries during the same time were medically unnecessary.

Two previous OIG reports based on the same sample of power wheelchairs found problems with coding and documentation requirements, and this report shows additional problems with suppliers' compliance with Medicare requirements. View those reports at http://oig.hhs.gov/newsroom/news-releases/2011/wheelchair-medicare.asp.

In all, the OIG determined that 80% of claims for power wheelchairs supplied to Medicare beneficiaries in the first half of 2007 did not meet Medicare requirements.

The OIG states that although CMS has taken steps since 2007 to decrease errors among suppliers of power wheelchairs and other DME, Medicare has paid significantly more in recent years for power wheelchairs than it did in 2007. These increases may indicate that CMS continues to pay for power wheelchairs that are not medically necessary and/or received claims that do not meet documentation requirements, according to the OIG.

The OIG recommends that CMS:

  • Enhance reenrollment screening standards for current suppliers of durable medical equipment, prosthetics, orthotics, and supplies
  • Review records from sources in addition to the supplier, such as the prescribing physician, to determine whether power wheelchairs are medically necessary
  • Continue to educate power wheelchair suppliers and prescribing physicians to ensure compliance with clinical coverage criteria
  • Review suppliers that submitted sampled claims we found to be in error

CMS concurred with the second, third, and fourth recommendations. CMS did not concur with the first recommendation.

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