title: Epidemiology of Medicare abuse: the example of power wheelchairs.
abstract: OBJECTIVE
  To determine the effect of neighborhood ethnic composition on power wheelchair prescriptions.
  
  
  METHODS
  The 5% noncancer sample of Medicare recipients in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, from 1994 to 2001.
  
  
  METHODS
  SEER regions.
  
  
  METHODS
  Individuals covered by Medicare living in SEER regions without a cancer diagnosis.
  
  
  METHODS
  Individual characteristics (age, sex, ethnicity, justifying diagnosis, and comorbidity), primary diagnoses, neighborhood characteristics (percentage black, percentage Hispanic, percentage with <12 years education, and median income), and SEER region.
  
  
  RESULTS
  The rate of power wheelchair prescriptions was 33 times greater in 2001 than in 1994, with a shift over time from justifying diagnoses more closely tied to mobility impairment, such as strokes, to less-specific medical diagnoses, such as osteoarthritis. In multilevel, multivariate analyses, individuals living in neighborhoods with higher percentages of blacks or Hispanics were more likely to receive power wheelchairs (odds ratios=1.09 for each 10% increase in black residents and 1.23 for each 10% increase in Hispanic residents) after controlling for ethnicity and other characteristics at the individual level.
  
  
  CONCLUSIONS
  These results support allegations that marketers promoting power wheelchairs have specifically targeted minority neighborhoods.
authors.affiliation: Department of Internal Medicine, School of Allied Health Sciences, University of Texas Medical Branch, Galveston, Texas 77555, USA. jsgoodwi@utmb.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
authors.forename: Tracy U
authors.initials: TU
authors.lastname: Nguyen-Oghalai
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D005260:Female; D005607:Fraud / Q000941:ethics / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008389:Marketing of Health Services / Q000191:economics / Q000941:ethics*; D006278:Medicare / Q000941:ethics*; D015999:Multivariate Analysis; D018426:SEER Program; D014481:United States; D014910:Wheelchairs / Q000191:economics / Q000941:ethics*