61% of Power Wheelchairs Medicare Provided were Medically Unnecessary

61% of Power Wheelchairs Medicare Provided were Medically Unnecessary

The Office of Inspector General (OIG) released a report today finding that 61% 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.

Based on their findings and prior work, the OIG recommends that the Centers for Medicare and Medicaid Services (CMS):

  1. enhance reenrollment screening standards for current suppliers of durable medical equipment, prosthetics, orthotics, and supplies;
  2. review records from sources in addition to the supplier, such as the prescribing physician, to determine whether power wheelchairs are medically necessary;
  3. continue to educate power wheelchair suppliers and prescribing physicians to ensure compliance with clinical coverage criteria; and
  4. review suppliers that submitted sampled claims we found to be in error.

CMS agrees with the second, third, and fourth recommendations, not the first recommendation.

Read the full report for more information on their findings.

Karen Fletcher
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.