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Only 13% Of Wheelchair Claims Valid, OIG Says

Published on Tue May 04, 2004

Wheelchair suppliers can expect even more scrutiny thanks to harsh reports from the HHS Office of Inspector General.
 
Of 230 K0011 wheelchair claims reviewed by an OIG contractor, only 13 percent met Medicare's coverage criteria for the item, the OIG says in a report released in conjunction with a Senate Finance Committee hearing (see "Feds Demonize Wheelchair Advertising in Senate Hearing").

Another 45 percent of reviewed claims qualified for a less expensive mobility device such as a scooter or manual wheelchair, while 31 percent didn't meet the Medicare coverage criteria for any mobility device, the OIG says in the report, "Medicare Payments for Wheelchairs" (OEI-03-02-00600). Reviewers couldn't determine whether 11 percent of the claims met K0011 criteria, due to insufficient documentation.

The 13 percent figure " is not a very good batting average -- in any league," said Senate Finance Chair Charles Grassley (R-IA).

But that very low figure just goes to show how subjective and confusing the wheelchair coverage criteria is, protests Erik Sokol with the Power Mobility Coalition. "They can use any pretext to deny a claim," Sokol insists. "The system has huge ambiguities."

The OIG also attacked payment rates for K0011 chairs. While Medicare's ceiling for the items was $5,297 in 2003, consumers could pay a median price of $3,863 over the Internet for the chairs, according to a second OIG report, "A Comparison of Prices for Power Wheelchairs in the Medicare Program," (OEI-03-03-00460).

And suppliers paid even less -- a median price of $2,363 from wholesalers and $1,550 when negotiating with manufacturers and distributors, the OIG maintains.

If Medicare used the prices available to consumers and suppliers, it could have cut $224 million from K0011 payments in 2002, the OIG says. And if it used the lower negotiated price, Medicare could have slashed $459 million from wheelchair payments that year, the report says.

Fraudster Draws Interest

Suppliers may also feel the screws tightening as the wheelchair fraud issue gains even more national attention. One of the witnesses in the hearing was Rebecca Lewandowski, who pled guilty to bilking Medicare of $25 million through power wheelchair fraud.

ABC News picked up on Lewandowski's testimony and interviewed her on the evening news for its "Your Money" segment. ABC also showed a video catching Lewandowski's organization's fraud on camera, which also was shown at the hearing. The video, taken by the OIG, showed a sham supplier setting up an office when told of a pending site visit from CMS.

In Lewandowski's scam, seniors received up to $1,500 or medical equipment for their Medicare numbers, reports the Houston Chronicle. The 24-year-old Oregon woman then used their numbers to bill Medicare for wheelchairs that usually were never delivered. 

Editor's Note: The OIG reports are at http://oig.hhs.gov/oei/reports/oei-03-02-00600.pdf and http://oig.hhs.gov/oei/reports/oei-03-03-00460.pdf.

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