OIG-HHS finds flaws in nearly two-third of powered wheelchair Medicare claims

by Ben Vernia | July 10th, 2011

“You may be eligible to receive a powered wheelchair at little or no cost to you!” claims one website pitching powered wheelchairs (or scooters). An OIG-HHS report issued July 7 says: “Probably not.”

According to the OIG, which examined powered wheelchair payments for 2007, 61% of such claims lacked medical necessity:

Based on records submitted by suppliers that provided power wheelchairs, 9 percent of all power wheelchairs were medically unnecessary and another 52 percent had claims with insufficient documentation to determine medical necessity. Beneficiaries who received power wheelchairs that were medically unnecessary needed a less expensive type of equipment (such as a manual wheelchair, cane, or walker) or a different type of power wheelchair. We also found that medical necessity and documentation errors varied by power wheelchair type. Standard power wheelchairs were less likely to be medically unnecessary than complex rehabilitation power wheelchairs (8 and 24 percent, respectively).

In addition, the OIG determined that 78% of claims which appeared to be medically necessary based on wheelchair suppliers’ records were medically unnecessary when physicians’ records were reviewed. In those cases, the doctors’ records either inadequately documented the medical need for the chairs, or they contradicted the suppliers’ records.

In all, the medically questionable claims accounted for $95 million – or about 1/2 of the $185 million spent in 2007 on powered wheelchairs.

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