OIG eyes power wheelchairs

Sunday, November 30, 2008

WASHINGTON--The rehab industry hopes the Office of Inspector General (OIG) will give providers a “fair shake,” as it takes a closer look at pricing for power wheelchairs.

The OIG stated in its FY 2009 Work Plan that it will “determine the appropriateness of Medicare payments for power wheelchairs.” In 2003, payments peaked at $1.2 billion, according to the OIG. In 2004, spending decreased to $850 million, but in 2005 it increased to $920 million.

Those numbers do not paint an accurate picture of the industry today, said Seth Johnson, Pride Mobility Products’ vice president of government affairs.

“The 2003 number is not a good benchmark for where spending really is or was because CMS recognizes that included significant fraud primarily in the Houston area,” he said.

Additionally, CMS implemented a “one step test” policy in late 2004, mandating that beneficiaries would only qualify for a power wheelchair if they couldn’t take one step on their own, said Cara Bachenheimer, Invacare’s vice president of government relations.
“That was a very restrictive new policy,” she said. “That should be reflected in 2005 data, not 2004.”

The OIG stated it will “review invoice prices for power wheelchairs and compare those prices to the Medicare fee schedule.” In 2004, the reimbursement rate paid by Medicare exceeded the prices suppliers paid by 242%, the OIG stated.

The OIG has been trying at least since March to survey providers to establish accurate acquisition costs and to identify non-product related costs incurred by providers of power wheelchairs, Johnson said. It could issue a report before the new year, he said.

For its part, the industry must do a better job of touting after-market services, said Don Clayback, The MED Group’s vice president of government relations.

“We need to document and quantify what goes on in providing a chair over and above the cost we pay manufacturers,” he said.