The government's tight scrutiny of K0011 claims in Harris County (Houston), Texas, could ease, according to Steve McAdoo, associate regional administrator for the Division of Medicare Financial Management in CMS' Dallas regional office. “We are in discussions with Palmetto GBA (Region C DMERC) to see whether or not we feel comfortable doing a modification in the level of review going on,” McAdoo said at a CMS June 23 Home Health, Hospice and DME Open Door Forum. “There could be some changes in the not-too-distant future.”
A strict 100-percent review for all power wheelchair claims submitted in the Texas county has remained in effect since last September, when CMS and the OIG launched Operation Wheeler Dealer in response to a sharp rise in power wheelchair expenditures and a massive fraud scheme involving the expensive equipment in Houston. Harris County providers' K0011 claims must be ”personally and individually approved” by members of a special CMS task force.
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