Senator Bob Corker, R-Tn., ranking member of the Special Committee on Aging, will chair a hearing to examine prior authorization requirements for power mobility devices in Medicare. A 2011 Inspector General’s report found that 80 percent of PMD claims did not meet Medicare criteria and should not have been paid.
The hearing, to be held on Wednesday, at 2 p.m. in 562 Dirksen, will review a three-year CMS demonstration project requiring prior authorization for power mobility devices (PMDs) in seven states where fraud with this benefit is most prevalent: California, Illinois, Michigan, New York, North Carolina, Florida and Texas. These states account for 43 percent of the annual spending on PMDs by Medicare.
Costs for PMDs range from $1,500 for scooters to $3,600 for more complex power wheelchairs over the course of the rental period. Medicare spending for PMDs accounted for $606 million in 2010. Overall, CMS paid $28.8 billion in improper payments in 2011 of which $5.9 billion was for durable medical equipment, which includes PMDs.
With a panel of witnesses representing key stakeholders impacted by this demonstration, the hearing will provide an opportunity for members of the committee to ask questions about the administration and management of the PMD benefit, the high rate of improper payments, waste, fraud, and abuse in this benefit, and the implementation of the demonstration as a remedy. Key areas for consideration include how to achieve a reduction in improper payments while also ensuring access to PMDs for legitimate claims.
Additional information, including witness testimony, and a live stream of the hearing will be made available at: http://aging.senate.gov/minority/public/.
U.S. Senate Special Committee on Aging:
Deborah Taylor, Chief Financial Officer and the Director of the Office of Financial Management, Centers for Medicare & Medicaid Services, Baltimore, MD
Paul J. Hughes, M.D., Medical Director, National Heritage Insurance Company, Durable Medical Equipment Medicare Administrative Contractor, Jurisdiction A, Lexington, SC
Stephen T. Peake, D.Ph., M.D., Medical Director, Senior Care Division, Blue Cross Blue Shield of Tennessee, Chattanooga, TN
Michael Clark, J.D., Senior Vice President and General Counsel, The SCOOTER Store, New Braunfels, TX
Jerome J. Epplin, M.D., FAAFM, Family Practitioner, Litchfield Family Practice Center, Litchfield, IL