November 11, 2016

DMEPOS Activities Included in OIG’s 2017 Work Plan

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The Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) has issued its fiscal year 2017 Work Plan, which includes OIG’s ongoing and forthcoming activities related to suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS). It provides healthcare industry stakeholders with a summary of new and ongoing reviews and activities that OIG plans to pursue regarding HHS programs and operations during the current fiscal year and beyond. The Work Plan priorities often result in additional enforcement action, significant change in Centers for Medicare & Medicaid Services (CMS) policy, or both.

The following is a summary of issues in the Work Plan that will directly impact O&P.

Medical Equipment and Supplies: OIG will conduct a study to determine the extent of inappropriate Medicare Part B payments for DMEPOS provided to nursing home residents during non-Part A stays in 2015, and determine whether CMS had a system in place to identify inappropriate payments for DMEPOS and recoup payments from suppliers.

Orthotic Braces—Reasonableness of Medicare Payments Compared to Amounts Paid by Other Payers: OIG will determine the reasonableness of Medicare fee schedule amounts for orthotic braces. OIG will compare Medicare payments made for orthotic braces to amounts paid by non-Medicare payers, such as private insurance companies, to identify potentially wasteful spending. OIG will estimate the financial impact on Medicare and on beneficiaries of aligning the fee schedule for orthotic braces with those of non-Medicare providers.

Orthotic Braces—Supplier Compliance With Payment Requirements: OIG will review Medicare Part B payments for orthotic braces to determine whether they were medically necessary and were supported in accordance with Medicare requirements.

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