OIG: Medicare improperly paid for PMD repairs

WASHINGTON – Medicare improperly paid $7.9 million for power mobility device repairs between Oct. 1, 2018, and Sept. 30, 2019, according to a new report from the Office of Inspector General. 

The OIG looked at Medicare Part B paid claims for 37,013 beneficiaries for whom suppliers submitted charges for 244,667 claim lines totaling $40.1 million for PMD repairs provided during the audit period.  (A claim line represented one PMD repair for a beneficiary on a single date of service.) A random sample of 100 beneficiaries was selected, for whom 52 suppliers submitted charges for 922 PMD repairs totaling $170,776. The OIG found that 637 of the 922 PMD repairs complied with requirements, and 261 did not. 

Specifically, the OIG found documentation did not adequately support the charges for PMD repairs, the labor time associated with PMD repairs was not documented, or PMD repair charges were not reasonable and necessary, resulting in $41,137 in improper Medicare payments and $10,494 in associated beneficiary coinsurance payments.  

The OIG also identified questionable charges for 183 PMD repairs associated with 19 sampled beneficiaries. Although the billing of these PMD repairs did not reflect noncompliance with Medicare requirements, suppliers did not meet documentation standards established by guidance or submitted charges that may not have been reasonable and necessary, resulting in $20,692 in questionable Medicare payments and $5,278 in associated beneficiary coinsurance payments. 

Based on these sample results, the OIG estimated that $7.9 million of the $40.1 million paid for PMD repairs was improperly paid. It also estimated that Medicare could have saved as much as an additional $3.7 million for questionably paid PMD repairs.  

The OIG conducted the audit to see if errors identified in a prior audit were still occurring. In that audit, for 2006 through 2008, the OIG found Medicare paid DME suppliers approximately $26.8 million for DME repair claims that did not meet Medicare requirements.