United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2004-04-28 monographic deposited born digital 23 p. GA 1.13:GAO-04-716T https://www.govinfo.gov/app/details/GAOREPORTS-GAO-04-716T P0b002ee1803850da f:d04716t DGPO 2010-08-12 2011-03-23 GAOREPORTS-GAO-04-716T machine generated eng fdlp REPORT GAOREPORTS-GAO-04-716T GAO-04-716T Claims processing Erroneous payments Fraud Health care programs Health insurance cost control Medical equipment Medical expense claims Prices and pricing Contractors Health care cost control Health insurance Managed health care Medicare Program Testimony A09894 Medicare spending for power wheelchairs, one of the program's most expensive items of durable medical equipment (DME), rose 450 percent from 1999 through 2003, while overall Medicare spending rose by about 11 percent for the same period, according to the Centers for Medicare & Medicaid Services (CMS). This spending growth has raised concerns that Medicare made improper payments and has payment rates that are out of line with market prices. In May 2003, the Department of Justice indicted power wheelchair suppliers in Texas alleged to have fraudulently billed Medicare. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) contains provisions regarding DME, such as changing payment setting methods. GAO was asked to examine (1) steps taken by CMS and its contractors to identify and respond to improper payments for power wheelchairs and (2) how MMA will affect CMS's ability to set payment rates for DME. To examine these issues, GAO analyzed claims data reports for CMS's four DME regions, reviewed applicable legislation, regulations, and CMS and contractor documents, and interviewed CMS and contractor officials, DME suppliers and manufacturers, DME industry representatives, and beneficiary advocacy groups. GAO focused attention on region C, which includes Texas. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-04-716T/html/GAOREPORTS-GAO-04-716T.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-04-716T/pdf/GAOREPORTS-GAO-04-716T.pdf GAO-04-716T https://www.govinfo.gov/app/details/GAOREPORTS-GAO-04-716T Testimony GAO-04-716T; Medicare: CMS Did Not Control Rising Power Wheelchair Spending; Claims processing Erroneous payments Fraud Health care programs Health insurance cost control Medical equipment Medical expense claims Prices and pricing Contractors Health care cost control Health insurance Managed health care Medicare Program Volume 111 Page 251 111 Stat. 251 Volume 113 Page 1501 113 Stat. 1501 Volume 117 Page 2066 Volume 117 Page 2223 Volume 117 Page 2224 117 Stat. 2066 117 Stat. 2223 117 Stat. 2224