OIG: Premier submitted 'unsupported' claims for prosthetics

Tuesday, January 8, 2013

WASHINGTON – Of 100 sampled claims for lower limb prosthetics submitted by Premier Prosthetics and Orthotics, a provider based in Creve Coeur, Mo., 43 claims were either not supported or only partially supported, according to the Office of Inspector General (OIG). The OIG believes, based on this sample, that the unsupported claims resulted in overpayments of $284,023 from Jan. 1, 2010, through Dec. 31, 2011. Of the 43 claims that did not conform to the requirements, the majority (35) lacked documentation in the medical records to support medical necessity. The OIG recommends that Premier refund $284,023 to the federal government, and strengthen its internal controls by implementing policies and procedures to ensure it collects and maintains the required documentation.