05/31/2024    

OIG NEWS

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 

 

Based on our review of the vulnerabilities identified in OIG’s prior work and our recent analysis of Medicare claims data, we identified issues related to the Centers for Medicare & Medicaid Services’ oversight of off-the-shelf (OTS) braces. Our analysis of claims data for calendar years 2018 through 2020 showed, among other findings, that Medicare paid for OTS braces that were:

 

(1) potentially unallowable replacement braces that did not meet reasonable useful lifetime requirements, (2) ordered by providers who did not have treating relationships with enrollees, or (3) marketed to enrollees by telemarketers using prohibited direct solicitation.   

 

Source: Read the Full Report