Fraud in the power wheelchair industry is a real issue. Medicare payments for power wheelchairs have increased by nearly 450%, from $289 million in 1999 to $1.2 billion in 2003. While it is imperative to root out fraud and abuse in the power wheelchair industry, it is equally important to ensure beneficiary access to power mobility devices. Power wheelchairs play an integral role in assisting millions of Americans who are disabled and/or elderly live independent lives, and allow them to be active participants in, and positive contributors to, our communities.
On September 9, 2003, the Department of Health and Human Services (HHS) and the Center for Medicare and Medicaid Services (CMS) announced a 10-point initiative, “Operation Wheeler Dealer,” aimed at curbing fraud, waste and abuse in the Medicare program as it relates to unscrupulous providers of power wheelchairs.
In response to this 10-point initiative, CMS released a Medicare policy coverage clarification in December 2003. This clarification stated that Medicare would no longer allow coverage of power wheelchairs for any patient who can take more than one step, even with the assistance of a cane, crutch or walker, to transfer from a bed to a chair. The clarification did very little to root out fraud and abuse at the source-the wheelchair providers. Rather, it had the potential to harm innocent Medicare beneficiaries who require power wheelchairs to maintain their independence and quality of life. In reality, this “anti-fraud” initiative unfairly and significantly limits patient access to wheeled mobility. On March 18, CMS rescinded this clarification.
The Senate Committee on Finance held a Congressional hearing on April 28 regarding this issue of fraud and abuse in the power wheelchair industry as it relates to Medicare. United Spinal Association submitted a statement for the record to the committee. Our statement urges the Committee to encourage CMS to update its Medicare national power wheelchair coverage policy to reflect nearly 40 years of legal advancements such as the Americans with Disabilities Act and the U.S. Supreme Court Olmstead decision, societal advancements such as acceptance of persons with disabilities into the American workforce, and technological advancements such as the development of power wheelchairs.
In its efforts to modernize, CMS must not further limit access to power and manual wheelchairs in its Medicare coverage policy as it did in the clarification. Such policies have many implications for people with disabilities and for the aging community and, therefore, for CMS as well. These implications include an increase in patients moving into nursing homes or assisted living facilities, increased reliance on full-time caregivers for accomplishing daily living activities, and the possibility of increased fractures resulting from a higher likelihood of falls. Actually, providing patients with the necessary power or manual wheelchair would probably end up costing Medicare less than what it will end up paying as a result of increased payments for assisted living facilities, rehabilitation units, and additional hospital visits.
It is undeniable that, in order to achieve and sustain community involvement, people with disabilities require access to mobility devices such as power wheelchairs. To this end, it is discouraging to watch CMS attempt to limit access to power wheelchairs through Medicare in its efforts to curb fraud and abuse. It is certainly possible to create a balanced policy that deters and detects fraud while preserving beneficiary access to power wheelchairs.
United Spinal Association urges CMS to update its Medicare national power wheelchair coverage policy, and to strike a balance in its efforts to root out fraud while still preserving beneficiary access to power wheelchairs.
For updates on this issue, please visit our Web site: www.unitedspinal.org
Kimberly Ruff-Wilbert is a Legislative Analyst.
