The second-highest biller for power wheelchairs received nearly $27 million in improper Medicare payments in 2010, according to a report from the Office of Inspector General (OIG).
Investigators found more than three-quarters of the claims submitted by Hoveround Corporation did not meet federal requirements for power mobility device (PMD) reimbursement, which requires a face-to-face encounter with a physician and a written prescription. In 144 claims, the Hoveround did not support medical necessity for the device, and in an additional 10 claims, the company provided incomplete documentation. Based on its findings, OIG estimated that more than $27 million of Medicare claims paid to Hoveround were improper, more than half of what the company received from Medicare in 2010.
Hoveround disagreed with the findings, arguing that the company did not submit all supporting documentation because it did not know that OIG was conducting a medical necessity review, and that OIG improperly extrapolated the results of the audit. However, OIG maintained Hoveround lacked the internal controls to ensure medical necessity and proper documentation of PMDs, and recommended Hoveround return the $27 million to the federal government.
Power wheelchair fraud has been a hot-button issue among federal regulators for more than a decade, as the Centers for Medicare & Medicaid Services (CMS) has reported improper payments rates of more than 80 percent for power wheelchair claims. The OIG has targeted power wheelchair claims citing the complexity and scope of fraud schemes that can lead to millions in fraudulent payments. In an effort to cut down on improper power wheelchair payments, CMS has implemented programs in 12 states across the country requiring pre-authorization for certain medical equipment.
For more:
- read the OIG report
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