When HHS’ inspector general’s office began looking into the Medicare program for prosthetic legs, something was … missing. A recent report identified 131 Medicare suppliers that in 2009 had questionable billing, such as billing for a high percentage of beneficiaries with no history of an amputation or a missing limb.
In addition, the inspector general also identified 136 prosthetic suppliers that frequently submitted claims that did not meet certain Medicare requirements or were for beneficiaries with no claims from their referring physicians, according to the report, called Questionable Billing by Suppliers of Lower Limb Prostheses. The report notes that Medicare paid an additional $61 million for beneficiaries with no claims from their referring physicians for the past five years. “Billing for prostheses when the beneficiary had no claims from the referring physician raises questions about whether the physician ever evaluated the beneficiary and whether these devices were medically necessary,” the report states.
The inspector general also says that between 2005 and 2009, Medicare spending for lower limb prostheses increased 27% to
$655 million, while the number of Medicare beneficiaries receiving lower limb prostheses decreased by 2.5% to about 74,000.
The CMS in response said it would work to improve its oversight of lower limb prostheses and make necessary changes.