GAO slams CMS for lax PWC oversight

Monday, January 31, 2005

WASHINGTON - CMS has made some gains correcting in-house problems that led to skyrocketing power wheelchair utilization, but it still has a long way to go, according to a critical new report from the General Accounting Office released in December.

The DMERCs began warning CMS about escalated spending for power wheelchairs in 1997. CMS officials, however, ignored the warnings until September 2003, the report stated. That’s when the giant Wheeler Dealer power chair fraud scandal broke out in Harris County, Texas.

Since then, CMS has taken steps to: 1. prevent fraudulent providers from entering the Medicare program; 2. ensure appropriate pricing for power wheelchairs; 3. conduct claims reviews where power chair fraud was prevalent.

The report recommended that CMS: 1. create a new CMN that would collect better information for claims review; 2. clarify guidance for providers on appropriate marketing; 3. require the DMERCs to routinely conduct less predictable site visits; 4. provide more clear coverage criteria.

CMS agreed with the recommendations and currently has initiatives in place to address them.

In 1997, Medicare paid about $100 million for power wheelchairs. It paid $1.2 billion in 2003.

Providers and industry leaders applauded the report. For more than a year, they have complained than the current CMN and coverage criteria for power chairs make it impossible to say with any certainty who will qualify for the benefit.

“We’ve been saying all along, give us some clear guidance and we’ll follow it,” said Eric Sokol, director of the Power Mobility Coalition. “We were interviewed for the report and are glad our comments were incorporated. We thought it was balanced.”

The GAO released its findings in a report entitled, “CMS’s Program Safeguards Did Not Deter Growth in Spending for Power Wheelchairs.” The report is a follow-up to a Senate Finance Committee hearing last spring. Sen. Charles Grassley, R-Iowa, called for that hearing following ongoing concerns about fraud and escalating power wheelchair payments.

“The report is really nothing new, but I like the title, and I can’t usually say that about GAO reports,” said Seth Johnson, director of government affairs for Pride Mobility Products.