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Medicare Reconsiders Claims Criteria for Wheelchairs

By Cindy Skrzycki
Tuesday, January 18, 2005; Page E01

For people with disabilities, motorized wheelchairs can be a great way to improve mobility, especially if the government will pick up most of the tab for the pricey machines, as Medicare does. But reports of fraud in 2003 led to a crackdown by the Centers for Medicare and Medicaid Services that has some manufacturers, suppliers and beneficiaries complaining the changes went too far.

The Medicare program recently introduced three major regulatory initiatives to tighten up eligibility, reduce payments and assure the legitimacy of the providers.

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The push for change began in September 2003, when a major Medicare fraud case was ferreted out in Houston. Claims for motorized wheelchairs in Harris County, Tex., skyrocketed to 31,000 in 2002 from 3,000 in 2001, according to agency records. A ring of fraudulent wheelchair purveyors in Houston was working with doctors, who falsified paperwork to make some recipients eligible, and then over-billing Medicare and not delivering the chairs they promised.

It was part of a spike in billings for motorized chairs over several years. Medicare payments jumped to $937 million in 2003, when the government approved 238,607 claims, from 110,614 approved claims and $409 million in payments in 2001.

As far back as 1997, CMS was alerted that spending on motor chairs was escalating and that inspecting suppliers was of little help because the site visits were "highly predictable." Yet the agency "did not begin to assume an active role" until September 2003, the Government Accountability Office told a Senate hearing last spring.

That was after the Houston Chronicle gave front-page prominence to the problem. The government then rolled out Operation Wheeler Dealer, a 10-point, industry-supported program to root out fraud.

The inspector general at the Department of Health and Human Services looked into the issue and found that only 13 percent of the 300 claims it examined met the eligibility criteria for the chairs. The inspector general also found that the agency was "excessively" reimbursing claims by thousands of dollars a chair.

Numerous indictments and some guilty pleas have followed. Nationwide, the government has 225 cases open against 390 suppliers and physicians. About $130 million in fraudulent payments has been recovered.

By December 2003, the contractors who process Medicare claims had a very strict definition of who was eligible. Only those who were confined to a bed or chair and could not operate a manual wheelchair qualified.

With all the attention, the numbers of claims and payments for motorized chairs dropped sharply last year. Through September, Medicare had approved 108,000 claims worth $416.5 million.

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