PITTSBURGH — Medicare is taking aim at questionable medical claims again, this time by requiring pre-approval for a number of medical devices that patients use in the home.

Critics say the new policy will bog down the process for getting oxygen, power wheelchairs and a variety of other supplies to patients – items they need to keep from being readmitted to the hospital. But citing years of abuse from inflated claims, Medicare anticipates savings from the initiative of $10 million in 2016, rising to $100 million by 2025, without hurting patient care.

Last year, Medicare spent $6.3 billion on medical equipment for use or treatment in the home. It hopes a pre-approval requirement for receiving some devices will reduce fraud. Associated Press

Penny Carey, president of Allegheny Health Network’s home medical equipment arm, is among the people who question the new policy.

“I don’t see how it can bring value to the consumer because you’re adding another regulatory burden,” she said. “I’m hoping it won’t, but if receiving authorization delays care, then the patient suffers.”

Starting Feb. 28, Medicare will require pre-authorization for some of the most commonly used home medical supplies, including oxygen and sleep apnea-related equipment, in a strategy that commercial insurers have used for years to curb overuse of medical testing. Medicare said it would answer requests for approval within 10 days, with a provision for expedited review within two days.

Seniors who have traditional Medicare fee-for-service will be affected by the new policy. People with Medicare Advantage health coverage will not be affected because those plans contract independently with providers.

Last year, Medicare spent about $6.3 billion on medical equipment that is needed at home to treat an illness or injury, significantly lower than the $7.4 billion the government spent in 2013. Requiring vendors to bid on supplying patients living in certain areas with specific kinds of equipment is credited for much of the savings.

And Medicare has had remarkable success with the pre-authorization lever in curbing power wheelchair claims. Claims for the mobility devices shrunk by one-fourth in the period from September 2012 to August 2015, according to Medicare. The pilot was conducted in 19 states and will be part of the program expansion that goes into effect nationwide next month.

Home medical equipment claim fraud is the stuff of legend. Medicare estimates that the agency improperly paid $1 billion for these claims between April 2006 through March 2007, at least partly because of fraud.

Separately, stolen beneficiary and physician identification numbers were used for five months starting in October 2006 to bill the government $5.5 million from three home medical equipment offices, one of which was a utility closet containing buckets of sand mix, road tar and a large wrench – but no office equipment.

Providers acknowledge past industry abuses, but say complicating patients’ ability to get medical equipment is not the answer.

“It’s going to have a greater impact on hospitals and patients than the durable medical equipment world,” said Tammy Zelenko, president of AdvaCare Home Services in the Pittsburgh area. “The beneficiary isn’t going to get what they need.”

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