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New OIG Report on Off-the-shelf Orthoses

Yesterday, the Centers for Medicare and Medicaid Services’ (CMS) Office of Inspector General (OIG) released a report entitled “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”. (link to OIG announcement) This report continues to highlight fraud and abuse vulnerabilities that exist through the provision of off-the-shelf (OTS) orthosis by unscrupulous providers. The report is one that AOPA has been expecting for a while and does not identify any new or surprising issues regarding the provision of OTS orthoses. AOPA has long been on record regarding the need to eliminate fraud and abuse by unqualified providers and bad actors and continues to support efforts by the OIG and CMS to take appropriate action to eliminate fraud and abuse in all its forms.

CMS Expands its Prior Authorization Program and Adds New O&P Codes Subject to Face-to-Face Encounters and Written Orders Prior to Delivery

On May 13, 2024, the Centers for Medicare and Medicaid Services (CMS) announced that the following six O&P HCPCS codes will require Medicare Prior Authorization nationwide for claims with a date of service on or after August 12, 2024: