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Orthotic Braces - Supplier Compliance with Payment Requirements

Medicare requires that suppliers' claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) be "reasonable and necessary" (SSA § 1862(a)(1)(A)). Further, local coverage determinations issued by the four Medicare contractors that process DMEPOS claims include utilization guidelines and documentation requirements for orthotic braces. Prior OIG work indicated that some DMEPOS suppliers were billing for services that were medically unnecessary (e.g., beneficiaries receiving multiple braces and referring physician did not see the beneficiary) or were not documented in accordance with Medicare requirements. We will review Medicare Part B payments for orthotic braces to determine whether they were medically necessary and were supported in accordance with Medicare requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed (partial) Centers for Medicare & Medicaid Services Orthotic Braces - Supplier Compliance with Payment Requirements Office of Audit Services A-09-17-03030;
A-09-17-03027;
W-00-17-35749
2019