DCS, the Region A recovery auditor, will recoup payments for additions to knee orthoses because they are included in reimbursement for specific base knee orthoses.

The new issue, posted Feb. 13, applies to 11 states. Maryland was not included in the post.

Knee orthoses also were part of two Medicare schemes in Puerto Rico that led to indictments of 10 people announced in January.

Both cases involved submission of false claims for durable medical equipment (DME) including knee orthoses and power wheelchairs, according to the Office of Inspector General (OIG).

In the 39-count indictment, the government alleges that one company submitted more than 1,500 false claims for medically unnecessary DME totaling almost $3 million. Medicare paid $1.4 million but put the company on prepayment review. At that point, two defendants bought a second company and submitted at least 359 fraudulent claims. When that company was put on prepayment review, defendants bought another company and submitted more than 100 more false claims, OIG stated. Medicare paid a total of more than $1.9 million on those claims.

The government seeks forfeiture of more than $1.9 million including two bank accounts, an investment account and a condominium, OIG stated. In a 60-count indictment, defendants submitted 95 fraudulent claims for DME for which Medicare paid almost $108,000.

RACs Post DME, Physician, Hospital Issues

Along with DCS's knee orthoses issue, Region C RAC Connolly posted a DME issue about therapeutic footwear use. RACs also posted two physician issues and two inpatient hospital issues.

Durable medical equipment