Tag: braces

WASHINGTON – CMS on Oct. 27 announced Round 2021 single payment amounts for off-the-shelf back braces and knee braces.   The agency has made contract offers for back and knee braces in 127 CBAs, a move that it expects to save $600 million for the Medicare program and beneficiaries over the three-year contract period.  CMS is not making offers for back and knee braces in certain CBAs where savings would not be achieved. Payment in those areas will be based on adjusted fee schedule...

ATLANTA - CGS has announced that the Jurisdiction B medical review department will begin complex post-pay service-specific reviews on back braces and test strips, according to the van Halem Group. Both reviews are the result of data analysis that indicates the allowed dollars for the two codes in Jurisdiction B are significantly above expected amounts. Each code also ranks high in the CERT Errors Top 15, with L0650 ranking No. 6 and A4253 No. 11, according to the van Halem Group. Based on earlier...

SAVANNAH, Ga. - Patrick Wolfe, operator of Wilmington Island Medical in Georgia, pleaded guilty to one count of conspiracy for his role in a scheme in which he paid kickbacks in return for leads for DME like orthotic braces and then billed Medicare Part B for the items.This prosecution stems from “Operation Brace Yourself,” a nationwide fraud takedown of a $1.2 billion scheme uncovered in 2019.The combined total of fraud charged in these Georgia cases, which include eight physicians,...

SAVANNAH, Ga. - Roderic Bain, the CEO of several DME companies based here, has been sentenced to more than three years in prison for allegedly defrauding Medicare of millions of dollars. Bain, who pleaded guilty to one count of false statements relating to healthcare matters, was also ordered to pay $1.9 million in fines and restitution. It's the first sentence handed down in “Operation Brace Yourself,” a nationwide fraud takedown that saw 24 defendants charged for their roles in a $1.2...

WASHINGTON - O&P stakeholders plan to use a recent massive fraud takedown involving medically unnecessary knee and back braces to advance upcoming legislation.The American Orthotic & Prosthetic Association has been trying to get legislation passed for several years that would curb fraud and abuse, and improve access to clinically appropriate care for beneficiaries.“It's great to see this first wave of charges,” said Todd Eagen, president of the Orthotic Prosthetic Group of America. “I...

WASHINGTON - HME industry stakeholders aren't surprised by a $1.2 billion fraud scheme involving medically unnecessary braces and they're glad to see “bad actors” punished.The feds last week charged 24 defendants with an alleged scheme involving illegal kickbacks and bribes by DME companies in exchange for referrals of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for back, shoulder, wrist and knee braces. “Stakeholders have been...

WASHINGTON - The federal government has charged 24 defendants, including executives at five telemedicine companies, the owners of dozens of DME companies and three licensed medical professionals, for their roles in a healthcare fraud scheme that resulted in $1.2 billion in losses.In addition, CMS's Center for Program Integrity has taken adverse administrative action against 130 DME companies that submitted more than $1.7 billion in claims and were paid more than $900 million.The charges target an...

TRACY, Calif. - Pacific Medical did not always comply with Medicare requirements when billing for selected orthotic braces, according to an audit by the Office of Inspector General. For 89 of the 100 sampled claims, the company complied with requirements, but for the remaining 11 claims, it did not. Specifically, Pacific Medical billed for orthotic braces that were not medically necessary for nine claims and could not provide medical records for two claims, the OIG says. “The deficiencies occurred...

WASHINGTON - CMS has extended a comment period for its plans to add new product categories to the competitive bidding program. The agency will now accept comments through Dec. 17. CMS included the new categories—ventilators and off-the-shelf knee and back braces—in a recent final rule. The proposal caught the industry by surprise and the inclusion of vents, in particular, has stakeholders concerned. AAHomecare has formed a ventilator workgroup to develop comments to the proposal. The...

TAMPA, Fla. - A new online store, Braces, Bandages & Beyond, has launched. The site carries a wide array of items like neck and back braces, splints, and compression stockings, as well as DME like wheelchairs. "I saw an unmet need in the marketplace and I wanted to fill that," said Greg Grambor, president of VascularPRN, a distributor of compression devices, who launched the site. "Braces, Bandages, & Beyond is my attempt to bring great selection, great service, and low prices together in a modern...