Senate committee shines spotlight on PWC utilization

Sunday, May 2, 2004

May 3, 2004

WASHINGTON - HME industry fears that a Senate Finance Committee hearing on power wheelchair fraud and abuse might further cripple the Medicare benefit came mostly to naught last Wednesday as federal officials revealed recommendations and plans that jive with the industry’s expectations.
Chairman Charles Grassley, R-Iowa, called the hearing in the wake of the Wheeler Dealer scandal in Houston last year and ongoing concerns about the escalation of payments for power wheelchairs. While Medicare paid a bit more than $100 million for power wheelchairs (PWC) in 1997, the program paid about $1.2 billion last year.
Just before the hearing began on Wednesday, CMS released a new three-pronged plan that builds on Medicare’s 10-point plan to combat fraud and abuse in the wake of the Houston scandal. The new initiatives will formulate new coverage policy for power wheelchairs, develop new codes for reimbursement and, per the MMA, revise the standards for participation as a Medicare supplier.
While the industry appears favorably disposed toward these developments, a pair of OIG reports provides less welcome news for an industry that feels unfairly tarnished by scam artists.
An OIG audit of 300 PWC claims found that only 13% of the beneficiaries qualified for the benefit while 31% did not meet the coverage criteria for any type of wheelchair, the OIG stated.
Bewildered by the suggestion that nearly nine out of 10 Medicare power wheelchair users doesn’t belong there, the industry is questioning the OIG’s methodology.
The industry is also troubled by the methodology used to obtain pricing information about power wheelchairs. In a second report, the OIG found that Medicare could have saved $459 million last year if CMS paid for power wheelchairs at the same price suppliers paid to wholesalers.
As a result, the OIG recommends that CMS either break up the K0011 code - an initiative that a significant portion of the rehab community supports - or implement IR to reduce reimbursement for power chairs.