OIG Report: Most Medicare Power Wheelchairs Fail Medical Necessity Guidelines

The Office of Inspector General (OIG) released a report stating they found that 61 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. These power wheelchairs accounted for $95 million of the $189 million that Medicare allowed for power wheelchairs during this period.

Recommendations to the Centers for Medicare and Medicaid Services (CMS), based on the OIG’s findings, included:
1. enhanced reenrollment screening standards for current suppliers of durable medical equipment, prosthetics, orthotics, and supplies;

2. reviewing records from sources in addition to the supplier, such as the prescribing physician, to determine whether power wheelchairs are medically necessary;

3. continuing to educate power wheelchair suppliers and prescribing physicians to ensure compliance with clinical coverage criteria; and

4. reviewing suppliers that submitted sampled claims we found to be in error.
After reviewing the report and recommendations, CMS agreed to all of the OIG’s recommendations except for enhanced reenrollment screening standards for current suppliers of DMEPOS.

AAHomecare’s Vice President of Government Relations, Walter Gorski, said, “Not only is the OIG report misleading, the OIG continues to draw the wrong conclusions from the results of the study. Government bureaucrats are overturning physicians’ medical judgment more than six out of every ten times. When the so-called error rate does not decrease despite continued efforts to educate providers over a period of several years, CMS and the OIG must look to simplify the coverage policy and inject common sense back into the auditing process.”

The American Association for Homecare’s Complex Rehab Power and Mobility Council is reviewing this report. To learn more, contact Alex Bennewith at 703-535-1891.