Mobility

OIG Report: More PWC Documentation Problems

The data is from 2007 and the trouble rests with physician education, HME advocates say, but will government officials care about that?
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"Not only is the OIG report misleading, the OIG continues to draw the wrong conclusions from the results of the study," said the association's Walt Gorski, vice president of government relations, in a statement issued Thursday afternoon. "Government bureaucrats are overturning physicians' medical judgment more than six out of every 10 times. When the so-called error rate does not decrease despite continued efforts to educate providers over a period of several years, CMS and the OIG must look to simplify the coverage policy and inject common sense back into the auditing process."

In a following blog, Gorski added that "power wheelchair providers are being put into a position of educating physicians on a very complex policy and then judging the physician's medical record competency. This should not be the power wheelchair provider's role."

The report validates what AAHomecare has been advocating for years, the blog said: "Lawmakers need to hold CMS accountable to establish clear and objective guidance to the physician community in the power mobility benefit."

But Sen. Thomas Carper, D-Del., also issued a statement about the OIG report that shows another view.

"When we see that more than half of Medicare's payments for power wheelchairs in a given time failed to meet the appropriate standards required for reimbursement, we know that something is very wrong and that the federal government can and must do better," Carper said.

Last month, Carper and Sen. Tom Coburn, R-Okla., introduced the Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers Dollars Act (S. 1251), or the FAST Act, which includes a provision that requires increased screening for Medicare providers. It also requires prepayment screening for all power wheelchairs and other DME "susceptible to fraud."

On July 12 (Tuesday), the Senate Subcommittee on Federal Financial Management, which Carper chairs, will hold a hearing on Medicare fraud and abuse.

Download a PDF of the 55-page OIG report.

Read AAHomecare's blog on the report.

Read Carper's full statement.

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