The Office of the Inspector General (OIG) released a report about the continuing problem of fraud, waste, and abuse in payments for off-the-shelf (OTS) orthotic braces.
From calendar years 2014-2020, Medicare paid approximately $5.3 billion for orthotic braces provided to Medicare enrollees. The Centers for Medicare & Medicaid Services (CMS) found that orthotic braces were consistently among the top 20 items of durable medical equipment, prosthetics, orthotics, and supplies with the highest improper payment rates. Adequate CMS oversight is critical in ensuring that Medicare enrollees continue to have access to and receive medically necessary braces, the report said.
Based on the review of the vulnerabilities identified in OIG’s prior work and the analysis of Medicare claims data, it identified the following issues related to CMS’ oversight of OTS braces:
- Providers ordered braces for enrollees for whom there was no history of a treating relationship.
- New suppliers were located in geographic areas with known Medicare fraud.
- Medicare paid more than private payers for OTS braces.
- Suppliers used prohibited solicitation to contact enrollees.
The report said that the issues continue to put Medicare and its enrollees at risk and demonstrate the need for CMS to strengthen its oversight related to supplier billing requirements, ordering provider requirements, supplier enrollment and monitoring, Medicare allowable amounts for OTS braces, telemarketing to Medicare enrollees, and fraud related to OTS braces.
To read the report, visit “Medicare Remains Vulnerable to Fraud, Waste, and Abuse Related to Off-the-Shelf Orthotic Braces, Which May Result in Improper Payments and Impact the Health of Enrollees.”
