Lower limb prostheses are designed to replace the function of a missing limb. The $43 million in overpayments were made to suppliers that incorrectly billed for prostheses for both right and left limbs using two claims instead of one, the report said. Medicare also paid an additional $61 million for beneficiaries with no claims from their referring physicians.
In light of these findings, the OIG has made six recommendations to CMS:
• Four durable medical equipment Medicare administrative contractors should implement claims processing edits.
• Monitoring of billing for lower limb prostheses should be increased.
• Referring physicians should document that a face-to-face encounter occurred with the patient.
• Local coverage of lower limb prostheses should be clarified.
• Suppliers of lower limb prostheses should endure more rigorous screening.
• Action should be taken on suppliers with questionable billing.
Related Articles on Billing Overpayments:
Geisinger Medical Center to Pay $1.3M to Settle Charges of Improper Medicare Billing
N.C. Baptist Hospital Pays $5.4M to Settle Claims of Overbilling Employees for Health Coverage
OIG Audit Finds Noridian Made $3M in Medicare Overpayments to Hospitals
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