Hearing scheduled to examine PMD waste and fraud

Friday, September 14, 2012

WASHINGTON – A Senate Aging Committee hearing next week will focus on new Medicare prior authorization requirements for power mobility devices (PMDs). The hearing, scheduled for Wednesday, Sept. 19, at 2 p.m., will review a three-year CMS demonstration project requiring prior authorizations for PMDs in seven states. The states under the microscope—California, Illinois, Michigan, New York, North Carolina, Florida and Texas—are where government officials believe PMD fraud is most prevalent. A 2011 Office of Inspector General report found that in these states, which together account for 43% of annual Medicare spending on PMDs, 80% of PMD claims did not meet Medicare criteria and should not have been paid. For the most part, industry stakeholders support the prior authorization requirements because they mean providers or physicians will get approval for claims before delivery of equipment. For the latest details on the PMD demo, read “Full steam ahead for PMD demo.”