The Medicare changes are an effort to stop fraud.
WASHINGTON (AP) -- Patricia Meier, a 63-year-old quadriplegic and Medicare recipient, needs to replace the wheelchair she has used for five years.
Normally, Meier could simply use her Medicare benefits to replace the power wheelchair, which adjusts her position to prevent sores, with another one from WestMed Rehab Inc., a medical supplier near her home in Box Elder, S.D.
But WestMed, along with several other suppliers across the country, says it will no longer provide power wheelchairs to most Medicare recipients after Nov. 15, when cuts in Medicare reimbursements go into effect. WestMed planned an announcement today.
The Medicare changes are intended to eliminate widespread fraud identified by the Health and Human Services Department, which oversees the program.
WestMed, based in Rapid City, S.D., is the only major wheelchair supplier within 300 miles of Meier's home. Concerned about the prospect of wheelchair supplies ending in their state, South Dakota's congressional delegation pressed federal health officials for more information.
If Meier were to replace her chair without using Medicare, it could cost her between 17,000 and 20,000. With Medicare, she would pay 20 percent of that.
"When I was able-bodied, I bought cars cheaper than that," said Meier, who was injured in a car accident 20 years ago. "I don't know how I would be able to afford it."
With other suppliers saying they, too, won't be able to provide mobility equipment to many of their customers, those living with multiple sclerosis, spinal cord injuries and other conditions could be without the wheelchairs they need to get around.
Many wheelchair users "are going to have to pay out of pocket," said Tim Pederson, CEO of WestMed Rehab.
Comparison of costs
A 2004 study conducted by the HHS inspector general showed that Medicare reimbursements for certain power wheelchairs were far higher than the prices paid by consumers and suppliers. According to the Centers for Medicare and Medicaid Services, which administers both health care programs, expenditures for power wheelchairs increased by 2,705 percent between 1995 and 2003 -- from 43 million to 1.2 billion in just over just eight years.
Agency spokesman Jeff Nelligan said the increase is a "direct result of the excessive prices Medicare pays for these products."
Most suppliers have supported overhauling the system, as many companies have abused it. But they say the government has gone too far.
The changes "do eliminate the fraud and abuse, but it also eliminates the benefit," said Pederson, of WestMed Rehab. "They are painting the entire industry in that broad brush, and they look at all of us as crooks."
Carol Gilligan, owner of Health Aid of Ohio Inc., said she will have to stop selling power wheelchairs altogether.
Several members of Congress have written to the agency in the weeks since the announcement. The entire South Dakota delegation sent a letter to the Health and Human Services Department on Wednesday asking for more information. Pennsylvania Sens. Arlen Specter and Rick Santorum, both Republicans, wrote the department last week asking for a delay in implementation of the new fees.
The Pennsylvania senators expressed concern about the payment formula used to calculate the reimbursements, noting that the formula does not always take current market prices into account.
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