OIG Report Comparing Medicare Payment for Orthoses with Payments by Other Insurers

On October 30, 2019, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report that compared Medicare payments for orthoses to payments made by non-Medicare payers from 2012-2015. The OIG cited an increase in Medicare payments for certain spinal, knee, elbow, and wrist orthoses from $631.8 million in 2012 to $815.5 million in 2015 as the reason for conducting its investigation. The OIG reported that for 142 orthosis codes, Medicare paid $337.5 million more than non-Medicare payers during the three-year review period. The OIG reported that for 19 orthotic codes, Medicare actually paid $4.7 million more than non-Medicare payers during the same three-year period.

View AOPA’s announcement here and view the full OIG report here.

Office of Inspector General Work Plans for O&P

The OIG no longer publishes a yearly work plan, rather they update their plans monthly. You may view and search the current active work plan items here.

2018 OIG Work Plan 
Read AOPA’s analysis

2017 OIG Work Plan 
Read AOPA’s analysis

2016 OIG Work Plan
AOPA’s Commentary on 2016 OIG Work Plan (on OIG’s concerns about being the lowest payer for orthotic bracing)
McGuire Woods Memo on “Medicare Most Favored Nations” Pricing Regulations

 Medicare Supplier Acquisition Costs for L0631 Back Orthoses

The following documents relate to the OIG report on LO631 and CMS’s attempted inclusion of O&P in Competitive Bidding.

AOPA Response to CMS Competitive Bidding List March 2012
OIG Report L0631 December 2012
AOPA Response to OIG Report on  L0631 January 8, 2013 
OIG Rebuttal to AOPA
AOPA Response to OIG Rebuttal April 19, 2013
AOPA Comments OTS List
AARP Bulletin March 2013
AOPA Response to AARP Bulletin March 2013 

Special Fraud Alerts

Renting Space from a Referral Source

Telemarketing by DMEPOS Suppliers

Giving Gifts to Patients