Medicare to rein in power wheelchair prescriptions, sales

The federal government will require greater oversight from physicians.

By Markian Hawryluk, amednews staff. Oct. 6, 2003.

Washington -- Faced with more than 300% growth in motorized wheelchair sales over the past four years, Medicare officials announced a full-force attack on wheelchair fraud and abuse this fall.

In a joint announcement, the Dept. of Health and Human Services' Office of Inspector General and the Centers for Medicare & Medicaid Services revealed an arsenal of measures designed to combat inappropriate Medicare payments for wheelchairs.

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"There shouldn't be any doubt here -- we are totally committed to providing motorized wheelchairs to the disabled and senior population," CMS Administrator Tom Scully said. "While many of these wheelchairs are provided by ethical suppliers and go to beneficiaries in need, we know that a great number of unscrupulous suppliers are promising free wheelchairs to beneficiaries who don't need them."

The agency will begin to scrutinize all new applications for wheelchair supplier numbers and is unlikely to approve any new suppliers until next year. Medicare contractors will be expected to pay additional attention to power wheelchair claims submitted for payment, and CMS will issue new regulations to clarify the conditions under which Medicare will cover mobility products.

And for the first time, physicians will be required to see patients before prescribing motorized wheelchairs or scooters.

"Hard as it is to believe, you can still today write a script for a wheelchair without seeing a patient," Scully said during the September conference call announcing the crackdown. "That seems pretty wild to me, that you can get a $5,500 piece of equipment without ever seeing" a doctor.

The number of power wheelchairs in one Texas county went from 3,000 in 2001 to 31,000 in 2002.

CMS, however, will expand wheelchair prescribing authority to all physicians. Previously, only specialists could approve a motorized wheelchair.

The agency will employ for the first time its inherent reasonableness authority, a mechanism by which CMS can lower prices for goods and services if they are not in line with market prices.

Durable medical equipment claims are paid under a fee schedule establish in 1984 and adjusted each year for inflation. CMS cannot change the DME fee schedule itself, other than an adjustment of up to 15% under the inherent reasonableness authority. Scully said he hopes better pricing of the products will help discourage suppliers intent on defrauding the government.

Medicare spending for motorized wheelchairs increased from $289 million in 1999 to a projected $1.2 billion in 2003.

"If you put the brass ring out, people are going to go for it, so we need to change the incentives," Scully said. "If we should be spending $1.2 billion, we should be spending that. But the growth rate is pretty phenomenal."

Eye on Texas

The campaign will commence in Harris County, Texas, where Medicare paid for more than 31,000 power wheelchairs in 2002, compared with just over 3,000 in 2001.

HHS Inspector General Dara Corrigan said enforcement efforts in this area would be heightened but that honest suppliers and physicians need not worry.

"This is not something that's gray. It's black and white," she said. "And we're going to be aggressively pursuing this throughout the country."

Corrigan said the scams hurt beneficiaries. The OIG has received calls from beneficiaries involved in a fraudulent scam years before who now need a wheelchair but cannot get one. "Beneficiaries are being taken advantage of, and a lot of money is being thrown around, but at the end of the day people are not getting what they need."

Senate Finance Committee Chair Charles Grassley (R, Iowa) said his panel had been investigating motorized scooter and wheelchair sales as well.

"Any Medicare beneficiary who legitimately needs a motorized wheelchair should get one," Grassley said. "But if companies are overselling their wheelchairs, or if doctors are approving these devices with too little scrutiny, then there's a problem."

Grassley has asked the Federal Trade Commission to investigate the motorized wheelchair companies' Medicare marketing practices, including the accuracy of representations made in print, television and radio advertisements.