The Centers for Medicare and Medicaid Services’ program
safeguards to limit spending on power wheelchairs have
failed, the Government Accountability Office has said
in a new report.
Classified as a durable equipment cost, spending on power
wheelchairs quadrupled from 1999 to 2003 while overall
spending rose by 11 percent, according to GAO-05-43.
It said the sharp rise in cost has raised concerns of
abuse, and that in May 2003 the Department of Justice
indicted several power wheelchair suppliers in Texas that
may have fraudulently billed Medicare.
Although contractors repeatedly warned CMS about spending
increases beginning in 1997, CMS did not take an active
role in addressing problems identified by the medical
directors of four contractors that pay DME claims until
late in 2003, said GAO.
It said illegitimate suppliers could prepare for and pass
site inspections because site visits were predictable,
though it added that since September 2003, CMS has moved
to prevent fraudulent suppliers from entering Medicare,
to clarify coverage policy, ensure power wheelchairs are
priced appropriately, and coordinate with law enforcement
agencies.
Yet, while CMS has made progress, “it has not implemented
a revised form to collect better information for power
wheelchair claims review, clarified guidance for suppliers
on appropriate marketing, or required its contractor to
routinely conduct less predictably timed site visits,”
said GAO.
It also said CMS’s response drew attention to another
matter, its lack of a process to investigate and address
improper DME payments.
