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Medicare and Orthotic Braces

Announced on  | Last Modified on  | Project Number: A-09-21-03019
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Prior OIG work identified inappropriate payments for orthotic braces that were not medically necessary, not documented in accordance with Medicare requirements, or fraudulent. We will compile the results of prior OIG audits, evaluations, and investigations of orthotic braces that were paid for by Medicare. We will also analyze data to identify trends in payment, compliance, and fraud vulnerabilities, and offer recommendations for improving detected vulnerabilities.

TIMELINE

REPORT PUBLISHED

Medicare Remains Vulnerable to Fraud, Waste, and Abuse Related to Off-the-Shelf Orthotic Braces, Which May Result in Improper Payments and Impact the Health of Enrollees (A-09-21-03019)

24-A-09-079.01 to CMS - Closed Implemented
Closed on 08/28/2024
We recommend that the Centers for Medicare & Medicaid Services determine why claims that did not have the required modifiers were paid for replacement OTS braces, and take steps to prevent payments for such claims.

24-A-09-079.02 to CMS - Closed Implemented
Closed on 10/03/2024
We recommend that the Centers for Medicare & Medicaid Services identify providers who ordered OTS braces for enrollees with whom they had no treating relationships and use that information to determine whether to provide additional education to—or take administrative or legal action against—the ordering providers or associated suppliers.

24-A-09-079.03 to CMS - Closed Implemented
Closed on 10/03/2024
We recommend that the Centers for Medicare & Medicaid Services analyze supplier billing patterns and use that information to determine whether to conduct additional prepayment or postpayment reviews of suppliers or impose a temporary moratorium on enrolling new suppliers of OTS braces if CMS determines that there is significant potential for fraud, waste, or abuse.

24-A-09-079.04 to CMS - Closed Superseded
Closed on 10/02/2024
We recommend that the Centers for Medicare and Medicaid Services review Medicare allowable amounts for OTS braces that are not currently in the DMEPOS Competitive Bidding Program to ensure that Medicare payments for OTS braces are reasonably comparable with payments made by non-Medicare payers, and determine whether to include any of those procedure codes for braces in future rounds of competitive bidding.

24-A-09-079.05 to CMS - Closed Implemented
Closed on 07/21/2025
We recommend that the Centers for Medicare & Medicaid Services educate suppliers and enrollees on telemarketing practices for OTS braces, specifically on not using direct solicitation of enrollees, and consider revoking billing privileges of suppliers that engage in prohibited solicitation practices.

24-A-09-079.06 to CMS - Closed Implemented
Closed on 10/03/2024
We recommend that the Centers for Medicare & Medicaid Services use predictive data analysis and information from other Federal agencies and from State agencies to identify emerging fraud schemes related to OTS braces, and use CMS's authority to prevent further losses to the Medicare program.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
-
Target Groups
Elderly
Financial Groups
Medicare B