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Audit (A-07-12-05026)

Lower Limb Prosthetics Claims Paid to Premier Prosthetics and Orthotics Were Not Always Supported by Adequate Documentation

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Of the 100 sampled claims for lower limb prosthetics that were submitted by Premier Prosthetics and Orthotics (Premier) a lower limb prosthetic supplier, 43 claims were either not supported or were only partially supported in accordance with Medicare durable medical equipment, prosthetics, orthotics, and supplies documentation requirements. Based on the results of our sample, we estimated that unsupported claims for lower limb prosthetics paid to Premier resulted in overpayments totaling $284,000 during the period January 1, 2010, through December 31, 2011.

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