OIG: Medicare overpaid for wheelchair repairs

WASHINGTON – Medicare paid $30.1 million in repair costs for wheelchairs that exceeded the federally recommended limit during their reasonable useful lifetime, according to a new report from the Office of Inspector General. 

Under Medicare, if the DME MACs determine that a beneficiary-owned wheelchair (after the 13-month rental period) will not last the full 5-year reasonable useful life (RUL), the supplier is responsible for replacing the wheelchair without charging the beneficiary or Medicare. The DME MACs can make this determination by considering whether the total cost of repairs exceeds 60% of the cost of the wheelchair. 

The OIG found that 73% of the repairs it reviewed from 2016-2021 were paid below the 60% replacement cost (504,794 out of 688,948 repairs). However, it found the remaining 27% of the repairs were beyond the 60% replacement cost. 

As a result, the OIG says 660 suppliers were potentially paid $30.1 million in unallowed Medicare payments and $7.6 million in unallowed coinsurance.  

The OIG made several recommendations to CMS to strengthen repair requirements: 

Strengthen Medicare requirements to ensure that DME MACs review accumulated costs of repairs made to wheelchairs during their 5-year RUL that exceed a certain cost limit and use this cost limit as a basis for determining when wheelchairs furnished by suppliers will not remain serviceable for their entire RUL; 

Implement system edits to identify for review claims for repairs made to wheelchairs during their 5-year RUL when the accumulated costs of repairs have exceeded a certain cost limit; and 

Take appropriate action for suppliers that consistently bill for repairs made to wheelchairs during their 5-year RUL that exceed the federally recommended cost limit or the cost limit used as the basis for determining when wheelchairs furnished by suppliers will not remain serviceable for their entire RUL (e.g., by educating suppliers on proper billing and recovering improper payments).  

CMS concurred with the recommendations.