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OIG Finds Majority of Wheelchairs Provided to Medicare Beneficiaries Did Not Fulfill Medical Necessity Guidelines

Medicare beneficiaries are able to obtain power wheelchairs when medically necessary under Medicare Part B. From 1999 to 2003, Medicare saw a 350 percent increase in payments for power wheelchairs. The $900 million jump raised concerns regarding the appropriateness of these Medicare payments. Although the new policies implemented in subsequent years lowered these numbers, Medicare payments for power wheelchairs remained high. As a result, the Office of Inspector General (“OIG”) selected a sample of 375 claims for power wheelchairs supplied in the first half of 2007 to Medicare beneficiaries for medical record review.

The resulting OIG report states that “[s]ixty-one percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 were medically unnecessary or had claims that lacked sufficient documentation to determine medical necessity.” The errors found varied by type of power wheelchair. Further, OIG stated that “[p]rescribing physicians’ records do not support the medical necessity of most power wheelchairs.”

As a result of the findings, the OIG proposed that the Centers for Medicare & Medicaid Services (“CMS”) follows the following recommendations:
1) Raise reenrollment screening standards for currently enrolled DMEPOS suppliers;
2) Review multiple sources to determine if the requested power wheelchairs fulfill medical necessity guidelines;
3) Further educate prescribing physicians and suppliers to ensure compliance;
4) Review the suppliers OIG found had committed errors.

CMS concurred with the second, third, and fourth recommendations, but failed to accept the first proposal.

For more information on government investigations, please contact Robert S. Iwrey, Esq. For assistance with compliance please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. The attorneys may be reached at (248) 996-8510 or (212) 734-0128. More information may also be obtained at the HLP website.

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