OIG: Medicare Paid $112M for Improperly Documented Power Wheelchair Claims

John Commins, for HealthLeaders Media , December 31, 2009

Three out of five claims for power wheelchairs did not meet Medicare documentation requirements in the first six months of 2007 and accounted for $112 million in improper payments, according to a report issued this week by HHS' Office of Inspector General.

OIG randomly selected 375 claims for standard and complex rehabilitation power wheelchairs from vendors supplying Medicare beneficiaries in the first half of 2007, and found that 60% of the claims did not meet one or more government documentation requirements. Two out of five claims had multiple errors. In addition, suppliers submitted incomplete documents almost three times as often as they failed to submit required documents, OIG reported.

Documentation error rates varied by power wheelchair type and supplier volume, OIG said. The specialty evaluation report was one of the documents most often not submitted by complex rehabilitation power wheelchair suppliers. Complex rehabilitation power wheelchair claims had a higher documentation error rate than standard power wheelchair claims. Standard power wheelchair claims submitted by low-volume suppliers had a higher documentation error rate than those submitted by high-volume suppliers.

Based on their findings, OIG has recommended that CMS:

  • Conduct additional reviews of standard and complex rehabilitation power wheelchair claims.
  • Recover overpayments and consider further actions against suppliers that do not meet documentation requirements.
  • Increase education for suppliers and prescribing physicians about documentation requirements.

OIG also wants CMS take appropriate action on sampled claims found to be in error.

CMS says it agrees with the recommendations, and has an action plan under way to improve compliance. CMS will also forward OIG's sampled erroneous claims to the appropriate contractors to identify and recover overpayments.

John Commins is a senior editor with HealthLeaders Media.

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