OIG Slams Medicare for Wheelchair Reimbursements, Again

Cheryl Clark, July 8, 2011

Medicare paid $95 million during the first half of 2007 for beneficiaries' power wheelchairs that were not medically necessary or for which claims lacked sufficient documentation, according to an audit released Thursday by the Office of Inspector General. 

The $95 million was 61% of the $189 million that the agency allowed for power wheelchairs – which cost between $4,132 to $11,965 – in the first half of 2007.

"Based on records submitted by suppliers that provided power wheelchairs, 9% of power wheelchairs were medially unnecessary and another 52% had claims that were insufficiently documented to determine whether the power wheelchairs were medically necessary," the OIG said.

For some of these beneficiaries, a less expensive type of equipment or a different type of power wheelchair would have sufficed.

By definition, power wheelchairs are approved for Medicare beneficiaries whose "mobility deficit cannot be addressed using other types of mobility-assistive equipment, such as a cane, manual wheelchair or scooter," the OIG report said.

Additionally, the beneficiary must be physically and mentally able to operate a power wheelchair and that person's home must provide adequate access between rooms for the wheelchair to operate. To qualify for more specific types of power wheelchairs, the beneficiary must satisfy other criteria. For example, his or her weight must be equal to the capacity of the power wheelchair.

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