August 21, 2018

August 21, 2018

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August 20, 2018

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OIG Published “Work Plan” Affecting Durable Medical Equipment Industry

On January 16, 2018, the Department of Health and Human Services Office of Inspector General (OIG) published its most recent update to the agency’s “Work Plan.”  Of note to Durable Medical Equipment (DME) manufacturers, suppliers and prescribers, OIG signaled increased interest in the investigation of three specific off-the-shelf orthotic devices identified by the HCPCS codes:

  • L0648—back bracing

  • L0650—back bracing

  • L1833—knee bracing

According to OIG, the government paid out $349 million for these braces in 2016, representing a 97% increase from just 2014.  OIG expressed concern that many of the braces were being prescribed without adequate documentation of medical necessity in patient records and also fulfillment in cases where actual physical examination of the patient had occurred over a year prior to the device being provided.

DME manufacturers, suppliers and prescribers of back and knee bracing should be advised that OIG has, and will, start taking a much closer look at any Medicare/Medicaid reimbursements for these devices and one can expect increased scrutiny in this area.

©2018 Epstein Becker & Green, P.C. All rights reserved.

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About this Author

Clay Lee Attorney Epstein
Attorney

CLAY T. LEE is an Associate in the Health Care & Life Sciences and Litigation & Business Disputes practices, in the Nashville office of Epstein Becker Green.

Mr. Lee:

  • Represents health care and life science companies in all aspects of litigation and in connection with federal and state government audits and investigations
  • Defends clients in criminal health care fraud cases and in False Claims Act matters (including qui tam litigation) based on...
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