To combat fraud, Medicare reducing reimbursements
There is no question that Keith Copen needs his motorized wheelchair. The 59-year-old is paralyzed from the thighs down and the chair helps him shop, get to his van, and travel over snow and ice.
But for the tens of thousands of seniors who got Medicare to buy them motorized scooters in recent years, the benefit is less clear.
Now the government is cracking down on fraud and abuse in wheelchair industry, and Copen might pay the price.
“Without this kind of chair, I can’t operate,” he said Tuesday.
Many wheelchair suppliers, including several in Denver, will no longer provide power wheelchairs to Medicare recipients after Nov. 15, when dramatic cuts in Medicare reimbursement go into effect.
“(The chairs) are just going to be out of reach, unfortunately, for these people who need them so badly,” said Marlene Tiffany, general manager of Adaptive Equipment Company, which is owned by Craig Hospital, an Englewood Rehabilitation and research center for patients with spinal cord injury and traumatic brain injury.
Medicare is planning to cut reimbursement for power wheelchairs on average 22 percent, and as much as 40 percent in some cases.
The changes were a reaction to a 2004 study conducted by the Health and Human Services Inspector General. It found that Medicare paid far more for certain wheelchairs than consumers and suppliers, at times $6,000 for a wheelchair that cost $1,000.
Also, between 1995 and 2003, the amount Medicare paid for power wheelchairs increased from $43 million to $1.2 billion.
“We’re cutting back only what we can call rampant fraud and abuse,” said Mike Fierberg, a spokesman for the Centers for Medicare and Medicaid Services.
The government took nine months to craft its new reimbursement schedule, which defines 56 categories of wheelchairs.
The changes were aimed at making it more difficult for moderately disabled seniors – people with “the dizzies and wobblies” – to get government-paid wheelchairs.
The severely disabled won’t be affected because “by and large, the more complex the chair, the smaller the impact of these (reimbursement) changes,” Fierberg said.
Suppliers, advocates and manufacturers agree that the payment system needs to be overhauled. But they say the government has gone too far, and will hurt severely disabled patients who rely on custom, complex chairs.
Patients with cerebral palsy, spinal cord injuries and muscular dystrophy need special chairs. The arm rests, head rest, joy stick and foot rests are specially fitted to match a person’s needs. The chairs’ suspension systems cushion curbs.
Suppliers say they will no longer stock such high-end chairs, since they’ll lose money selling them.
“For Keith, his only option is to go to a lesser chair,” Tiffany said.
Longmont-based Sunrise Medical, the No. 2 manufacturer of power wheelchairs in the U.S., will trim research and development, and be forced to push manufacturing overseas, said Sunrise’s Dr. Robert Hoover.
“We can certainly build chairs that can meet the new specifications,” Hoover said. “But I don’t think it’s a chair you’d want to put your family member in.”
By Rachel Brand, Rocky Mountain News
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