Corporate Compliance

OIG report: Questionable billing by suppliers of lower limb prostheses

Compliance Monitor, August 24, 2011

Medicare inappropriately paid $43 million for lower limb prostheses that did not meet certain Medicare requirements in 2009, according to a report by the Office of the Inspector General (OIG).

Lower limb prostheses are designed to replace, as much as possible, the function of a missing limb. The incorrect payments could have been prevented by using claims processing edits, according to the report. The Medicare requirements the OIG reviewed stipulate how suppliers must submit claims for certain prostheses.

Medicare paid an additional $61 million for beneficiaries with no claims from their referring physicians. Medicare requires that a supplier have an order from a physician before providing the prostheses to the beneficiary, according to the OIG.

The OIG also reported 267 suppliers of lower limb prostheses submitted questionable billing, including suppliers that frequently billed for unusual combinations of prostheses or for beneficiaries who had no history of an amputation or missing limb.

Read the full OIG report.


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