Medicare Paid $30 Million for Accumulated Repair Costs That Exceeded the Federally Recommended Cost Limit for Wheelchairs During Their 5-Year Reasonable Useful Lifetime

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Monday, July 31, 2023

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-09-22-03003

Component, if applicable:

Centers for Medicare & Medicaid Services

Centers for Medicare and Medicaid Services

External entity, if applicable:

Center for Medicare and Medicaid Services

Location(s):

United States

Type of Report:

Audit

Questioned Costs:

Funds for Better Use:

$30,051,107

Number of Recommendations:

Report updated under NDAA 5274:

View Document:

Attachment	Size
92203003.pdf	1.13 MB

Recommendation Number	Recommendation Status	Significant Recommendation
23-A-09-092.01	Open	No
We recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which if in effect during our audit period could have saved Medicare as much as $30,051,107 for wheelchair repairs: strengthen Medicare requirements to ensure that DME MACs review accumulated costs of repairs made to wheelchairs (including wheelchairs purchased on a lump-sum basis) during their 5-year RUL that exceed a certain cost limit and use this cost limit as a basis for determining when wheelchairs furnished by suppliers will not remain serviceable for their entire 5-year RUL.
23-A-09-092.02	Open	No
We recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which if in effect during our audit period could have saved Medicare as much as $30,051,107 for wheelchair repairs: review accumulated costs for wheelchair repairs that exceed the federally recommended cost limit, and for those wheelchairs that the DME MACs determine will not remain serviceable for their entire 5-year RUL, enforce Federal requirements by requiring the suppliers that transferred ownership of the wheelchairs purchased on a rental basis to enrollees to furnish replacement wheelchairs to those enrollees at no cost to the enrollees or to Medicare.
23-A-09-092.03	Open	No
We recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which if in effect during our audit period could have saved Medicare as much as $30,051,107 for wheelchair repairs: implement system edits to identify for review claims for repairs made to wheelchairs during their 5-year RUL when the accumulated costs of repairs have exceeded a certain cost limit.
23-A-09-092.04	Open	No
We recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which if in effect during our audit period could have saved Medicare as much as $30,051,107 for wheelchair repairs: take appropriate action for suppliers that consistently bill for repairs made to wheelchairs during their 5-year RUL that exceed the federally recommended cost limit or the cost limit used as the basis for determining when wheelchairs furnished by suppliers will not remain serviceable for their entire 5-year RUL (e.g., by educating suppliers on proper billing and recovering improper payments).

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

23-A-09-092.01

Open

We recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which if in effect during our audit period could have saved Medicare as much as $30,051,107 for wheelchair repairs: strengthen Medicare requirements to ensure that DME MACs review accumulated costs of repairs made to wheelchairs (including wheelchairs purchased on a lump-sum basis) during their 5-year RUL that exceed a certain cost limit and use this cost limit as a basis for determining when wheelchairs furnished by suppliers will not remain serviceable for their entire 5-year RUL.

23-A-09-092.02

Open

We recommend that the Centers for Medicare & Medicaid Services work with the DME MACs to do the following, which if in effect during our audit period could have saved Medicare as much as $30,051,107 for wheelchair repairs: review accumulated costs for wheelchair repairs that exceed the federally recommended cost limit, and for those wheelchairs that the DME MACs determine will not remain serviceable for their entire 5-year RUL, enforce Federal requirements by requiring the suppliers that transferred ownership of the wheelchairs purchased on a rental basis to enrollees to furnish replacement wheelchairs to those enrollees at no cost to the enrollees or to Medicare.

23-A-09-092.03

Open