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Audit (A-07-12-05035)

Durable Medical Equipment Claims Paid by Noridian Healthcare Solutions, LLC, Did Not Always Meet the Requirements of the Local Coverage Determination for Lower Limb Prostheses

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Noridian Healthcare Solutions, LLC (Noridian), paid $97,000 for 48 lines of service for lower limb prostheses from January 1, 2010, through December 31, 2011, that did not meet local coverage determination (LCD) requirements.

We recommended that Noridian (1) recover $97,000 in identified overpayments for lines of service for lower limb prostheses that did not meet LCD requirements and (2) continue to monitor the edits it developed and updated to ensure that they are functioning correctly. Noridian stated that it had recouped or was in the process of recouping all of the overpayments that we had identified. Noridian also described corrective actions that it had taken.

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