Power Mobility Coalition Voices Concern Over Government Reports Outlining Lack of...

Power Mobility Coalition Voices Concern Over Government Reports Outlining Lack
of Oversight in the Medicare Durable Medical Equipment Benefit

Organization Calls on Medicare to Expedite Mandatory Accreditation, Adopt
Clearer Documentation Standards

WASHINGTON, Sept. 2 /PRNewswire-USNewswire/ -- The Power Mobility Coalition
(PMC), an association of manufacturers and suppliers of power mobility
devices, raised concerns today about recent findings that questioned whether
the Center for Medicare & Medicaid Services (CMS) accurately reviewed durable
medical equipment (DME) claims that suppliers submitted for reimbursements
after providing medical equipment to Medicare beneficiaries.

The Health and Human Services (HHS) Office of the Inspector General (OIG)
report entitled, Medical Review of Claims for the Fiscal Year 2006
Comprehensive Error Rate Testing Program (A-OI-07-00508), compared an OIG and
CMS review of the same Medicare DME claims, including power mobility devices,
which resulted in vastly different error rates. The CMS contractor assessed a
7.5% error rate while an OIG contractor assessed a 28.9% error rate.

To help correct problems, the OIG recommended that physicians receive
additional documentation training and that CMS issue a written policy
clarifying the review process to be followed by their Medicare contractors.
The PMC has worked with Congress, CMS, physician organizations, and suppliers
to establish an objective documentation standard to provide consistency in the
DME claims process.

It is evident by the report, however, that an objective standard still eludes
CMS as attested by the differing interpretations of the DME claims process by
both OIG and CMS. "It appears that there is inconsistency in determining
what constitutes medical necessity for Medicare beneficiaries to obtain the
equipment," says Stephen Azia, PMC Counsel. "The physician must be the
gatekeeper of the PMD benefit and the veracity of his or her best medical
judgment should not be second-guessed by a medical reviewer who has never seen
or examined the beneficiary. These results just highlight what we have been
concerned about for years."

The OIG report comes on the heels of a report from the Government
Accountability Office (GAO) that also highlights deficiencies in the Medicare
program's fraud prevention efforts. According to the GAO report entitled,
Medicare: Covert Testing Exposes Weaknesses in the Durable Medical Equipment
Supplier Screening Process (GAO-08-955), investigators set up two fictitious
DMEPOS companies using undercover names and bank accounts. CMS approved the
companies for Medicare billing privileges despite having no clients and no
inventory, exposing vulnerabilities in the DME enrollment and inspection
process.
The PMC has long supported efforts to prevent fraudulent companies from being
approved for the Medicare program, including a mandatory accreditation
requirement and more rigorous standards that were included as part of the
Medicare Modernization Act of 2003. Accreditation by a nationally recognized
accreditation body will provide additional accountability, ensure program
integrity and safeguard taxpayer resources.
Unfortunately, when Congress directed CMS to delay the competitive bidding
program for medical equipment, CMS also cancelled the accreditation deadlines
for suppliers, which will slow the accreditation process. While CMS still
maintains a mandatory accreditation deadline of September 30, 2009 for all
suppliers, they have ended the phase-in that accompanied competitive bidding,
and would have resulted in more suppliers being accredited.

"Congress should make it clear to CMS that the delaying of competitive bidding
was not meant to delay any mandatory accreditation requirements that can be
useful in the fight against fraud," says Eric Sokol, PMC Director. "PMC
strongly urges that a new phase-in schedule should be developed and
implemented immediately. It is our hope that we can work with CMS during this
critical time and establish meaningful barriers to keep fraudulent companies
out of the Medicare program."

In many cases, unscrupulous actors would not have been permitted into the
program if they were subjected to mandatory accreditation. "All legitimate DME
suppliers have an interest in ridding the Medicare program of bad actors," Mr.
Azia explained. "Accreditation is a powerful tool that will help in
eradicating the fraudsters, save the Medicare program and American taxpayer's
money and ensure that eligible beneficiaries receive quality medical equipment
from lawful suppliers."

The Power Mobility Coalition (PMC) is a nationwide association of
manufacturers and suppliers of motorized wheelchairs and power operated
vehicles based in Washington, DC.

CONTACT: Eric Sokol of The Power Mobility Coalition, +1-202-296-3501

SOURCE The Power Mobility Coalition

Eric Sokol of The Power Mobility Coalition, +1-202-296-3501