Most K0011 claims flunk OIG scrutiny

Sunday, May 2, 2004

May 3, 2004

WASHINGTON - An OIG review of 300 random K0011 claims filed in 2001 found that a meager 13% met Medicare’s coverage criteria, and that 31% did not meet the coverage criteria for any kind of wheelchair.
The OIG presented its audit report, “Medicare Payments for Power Wheelchairs”, to members of the Senate Finance Committee on April 28. The committee convened to gather data on skyrocketing power wheelchair utilization.
In 2001, the OIG reported, Medicare and its beneficiaries paid $513 million for all K0011s. Based on its audit, however, the OIG found that $178 million of those claims did not meet Medicare’s coverage criteria.
The OIG embarked on its audit to discover why Medicare payments for K0011 power chairs jumped 43% between 2000 and 2001.
“Although many beneficiaries need power wheelchairs, DMERCs and the OIG have identified fraud cases involving power wheelchairs that were not supplied, not medically necessary, or both,” the OIG wrote in its report.
The OIG also blamed the increase on providers, physicians and beneficiaries who don’t understand K0011 coverage criteria.