The federal government continues its crackdown on Medicare fraud in the powered wheelchair industry as CMS Administrator Mark McClellan, M.D., today announced a three-pronged approach to tighten administrative controls, focusing on coverage, payment and quality of equipment.
"Medicare spending for power wheelchairs and power scooters has skyrocketed in recent years to more than $1.2 billion a year, yet some beneficiaries who really need these mobility devices are not getting high-quality and timely assistance," said McClellan in a news release.
"CMS has cracked down on fraud and abuse in the wheelchair market, including the launch of Operation Wheeler Dealer last fall in collaboration with the HHS Office of the Inspector General," said McClellan. "Now we are moving to the next stage in strengthening our policies for power mobility devices."
Next month, CMS will ask clinicians for help drafting an evidence-based definition of "bed or chair confined" to better predict who would benefit from a powered wheelchair or scooter. Public comments also will be solicited.
CMS will look into appropriate payments for the devices, most of which are billed under a single code with a set ceiling amount of $5,296.50. The agency plans to set up multiple codes that better describe what is on the market today.
CMS also said it will open the durable equipment items for competitive bidding under provisions of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
Finally, CMS said it will develop quality control standards for equipment providers that supply the devices to Medicare beneficiaries.
Under Operation Wheeler Dealer, the justice department and the CMS Office of Inspector General have recovered $84 million in fraudulent claims for power mobility products, with Medicare claims processors referring 155 cases of potential fraud against 264 suppliers since September 2003.
Also today, Dara Corrigan, the IOG's principal deputy inspector general, appeared before a Senate finance committee armed with two of her office's reports on Medicare spending on power wheelchairs.
The reports, released today, found that Medicare overpaid for power wheelchairs by $224 million in 2002 alone and that only 13% of Medicare claims for the chairs taken from a 2001 sample actually met the coverage criteria.