While the pharmaceutical industry is gradually changing its wayward ways, certain durable medical equipment (DME) counterparts are still cemented in a culture of deceit. This message was, once again, echoed in a scathing HHS-OIG report, Most Power Wheelchairs in the Medicare Program Did Not Meet Medical Necessity Guidelines (OEI-04-09-00260). According to an HHS-OIG investigation of FY2007 power wheelchair claims, 52% of the claims lacked sufficient documentation and at least 9% of the claims were medically unnecessary.
“Of the $189 million that Medicare allowed for power wheelchairs provided in the first half of 2007, $95 million was for power wheelchairs that were medically unnecessary or had claims that were insufficiently documented,” OIG said.
OIG conducted medical record reviews on 375 claims for standard and complex rehabilitation power wheelchairs supplied to beneficiaries in the first half of 2007.
This report comes on the heels of two previews OIG reports that looked at the same sample of claims. “Across all three reports, 80 percent of claims for power wheelchairs supplied to beneficiaries in the first half of 2007 did not meet Medicare requirements,” the report said.
The only way to fully ferret out fraud in the DME industry is to review the medical records from sources, such as the prescribing physician, in addition to the supplier, to determine whether power wheelchairs are medically necessary. It will also take more insiders to expose the ever-prevalent kickback payments which continue to exist within the industry. With inadequate government oversight and thousands of new suppliers entering the market every single year, the DME industry is a breeding ground for fraudsters.
Nolan & Auerbach, P.A. handled a successful whistleblower case regarding unnecessary power wheelchairs over a decade ago. Despite its courageous whistleblower and star Assistant United States Attorney in that case, subsequent cases of the same fraud continue to pop up all over the country. The federal government needs the assistance of whistleblowers to expose dishonest providers and DME suppliers, and once and for all put an end to these dishonest practices.
For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.