Relaunch of CMS Audits – Focus on Orthopedics

August 11, 2020

by Sean Weiss, Partner & VP of ComplianceKeeping with the theme regarding the relaunch of audits by CMS and OIG that began on Aug. 3, 2020 and the fact they indicated initial focus would be on DME, I’m sharing a report issued August 10,2020 by OIG for CMS Payments on Orthotic Braces. This has been a big target for Ortho Practices in the past resulting in significant take-backs due to the “Reasonable Useful Lifetime”. Under the regulations at 42 CFR 414.210(f), the reasonable useful lifetime of durable medical equipment, prosthetic and orthotic devices is 5 years unless program instructions authorize a specific reasonable useful lifetime of less than 5 years for an item.
Ortho practices and/or any practice that issues DME prosthetic and orthotic devices must check the payor system to determine the last time a patient was issued one of these to avoid costly repayment on the back-end. This is and remains a hot target area for CMS and OIG and all must take heed! The report demonstrates just how costly this can be. The group is repaying $2.8 million! Desoto Home Health Care, Inc: Audit of Medicare Payments for Orthotic Braces

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