(OEI-04-09-00260) http://go.usa.gov/Zvm We found that 61 percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 were medically unnecessary or had claims that lacked sufficient documentation to determine medical necessity. These power wheelchairs accounted for $95 million of the $189 million that Medicare allowed for power wheelchairs during this period.
Based on our findings and prior work, we recommend that CMS:
(1) enhance reenrollment screening standards for current suppliers of durable medical equipment, prosthetics, orthotics, and supplies;
(2) review records from sources in addition to the supplier, such as the prescribing physician, to determine whether power wheelchairs are medically necessary;
(3) continue to educate power wheelchair suppliers and prescribing physicians to ensure compliance with clinical coverage criteria; and
(4) review suppliers that submitted sampled claims we found to be in error.
CMS concurred with the second, third, and fourth recommendations. CMS did not concur with the first recommendation.
