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National Government Services, Inc., Paid Unallowable Lower Limb Prosthetics Claims

National Government Services, Inc. (NGS) (operating in Indiana), paid $1.5 million for 770 lines of service for lower limb prostheses from January 1, 2009, through September 30, 2012, that did not meet local coverage determination (LCD) requirements.

We recommended that NGS (1) recover $1.5 million 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. NGS stated that it had recouped or was in the process of recouping all of the overpayments that we had identified. NGS also described corrective actions that it had taken.

Filed under: Center for Medicare and Medicaid Services