OIG identifies $6M in prostheses that don’t meet requirements

Tuesday, July 23, 2013

WASHINGTON – CGS Administrators paid $6 million for 4,260 lines of service for lower limb prostheses in 2010 and 2011 that did not meet local coverage determination (LCD) requirements, according to a report from the Office of Inspector General. At the time CGS paid for these lines of service, it did not have edits in place to evaluate whether or not they met all the LCD requirements. In 2012, CMS directed CGS and the other DME MACs to put in place edits for all requirements in the LCD for lower limb prosthetics. The OIG recommends that CGS recover $6 million in identified overpayments for lines of service for lower limb prostheses that did not meet the requirements in 2010 and 2011; and monitor the edits it has developed since 2012 to make sure they’re working correctly. CGS concurred with the recommendations and plans to take corrective actions. FMI: http://go.usa.gov/jWGH.