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Power Wheelchair Companies Fight Fraud
April 28, 2004 - A coalition representing the power
wheelchair industry today announced a 10-point plan designed to curtail
Medicare fraud, while ensuring that their products remain accessible to
senior citizens and Americans with disabilities.
RAMP, the Restore Access to Mobility Partnership,
asserts that the 10-point plan would help the Centers for Medicare and
Medicaid Services (CMS) fight fraud without harming the people who
require power wheelchairs to increase their mobility. It recommends
establishing an accreditation process for suppliers, implementing a
clear and clinically appropriate documentation process and appointing a
fraud task force.
"We want to work together with CMS to curtail fraud
and ensure that restrictive coverage policies do not stop seniors and
Americans with disabilities from obtaining the medical equipment that
can increase their quality of life," said Michael Hammes, chairman and
CEO of Sunrise Medical.
Scott Meuser, CEO of Pride Mobility Products Corp.,
noted that CMS should work with the industry to avoid adopting
restrictive coverage policies that deny access to medically necessary
mobility products as a means to fight fraud. CMS adopted such a policy
in December, which limited reimbursements to those who were completely
chair and bed confined. After sharp criticism from groups representing
the disabled and the industry, CMS later retracted the policy.
"Going forward we need a comprehensive plan that
outlines coverage guidelines, but we also need a comprehensive plan for
fighting fraud," Mr. Meuser said. "Currently, there are mechanisms
available and by working with CMS to implement this plan, we can achieve
both goals."
Specifically, RAMP recommended:
1. Fraud Task Force -- With industry assistance,
organize a Special Task Force and Implementation Strategy to combat
fraud and abuse. CMS, OIG, and the industry can work together to
eliminate fraud. The industry would serve on the task force with CMS
representatives.
2. Comprehensive Coverage Policy -- CMS should
establish a clear national coverage policy for mobility products. This
would establish national guidelines that would end confusion over
coverage policy.
3. Provider/Supplier Accreditation -- Requirement
for all Medicare/Medicaid mobility suppliers to be accredited by a
nationally recognized accrediting organization. This measure will
improve the standards for suppliers.
4. Advanced Rehab Certification -- Requirement for
a strict certification plan for medical suppliers who provide advanced
rehab equipment for disabled pediatric and the severely disabled. This
will help ensure that only qualified, certified individuals are
responsible for the treatment of individuals with severe disabilities.
5. Medical Documentation Requirements -- Establish
that a certificate of medical necessity (signed by a physician) with a
corroborated state licensed Physical Therapist or Occupational Therapist
evaluation is required documentation to establish non- ambulation and
whether a mobility product (e.g.; power wheelchair) is medically
necessary. This will provide clarity for providers and physicians as to
the proper documentation requirements to establish medical necessity.
6. Advisory Group on Mobility Issues -- Appoint
representatives from groups representing persons with disabilities,
consumers and the industry to advise CMS on issues related to mobility
questions. The group would be a sounding board for CMS, so that they
could better gauge the impact of any new policies or guidelines.
7. New Code Development -- CMS should establish new
codes for mobility equipment as the industry has recommended. There is
such a vast range of technology that old codes need to be updated to
adequately differentiate between the products.
8. Establish Advertising Best Practices --
Establish clear advertising regulations for the health care industry.
This will help prevent non-compliance with Medicare Standards. Many
other industries have advertising requirements and regulations, the
power wheelchair industry can also accept them.
9. Fraud Reporting System -- We will work with CMS
to establish an enhanced fraud and reporting system, which will help
curtail fraud, as well as encourage people to report any irregularities.
10. Regulatory Reform -- Implement the Regulatory
Reform procedures outlined in the Medicare Modernization Act that
establish a clear procedure for reviewing medical claims and providers
to determine compliance with established documentation requirements. It
is essential that clarity in medical documentation be established to
achieve efficient claim processing.
"This is an opportunity for CMS, the industry and
representatives of disabled Americans to sit down and hammer out a plan
that will limit fraud and abuse," said Mal Mixon, Chairman and CEO of
Invacare Corp. "The industry is prepared to do its part. We want to
clean up fraud and abuse just as much as the government does. By working
together, we can achieve that goal without limiting access to power
wheelchairs to the consumers that need them to improve their mobility."
The Restore Access to Mobility Partnership is a
coalition of organizations and companies representing power wheelchair
providers and manufacturers. Its members include: the American
Association of Homecare; Invacare Corporation; the MED Group; Mobility
Products Unlimited, LLC; Pride Mobility; The SCOOTER Store; and Sunrise
Medical. |
