The OIG and DOJ published have filed against 24 individuals involved in what the FBI is calling one of the largest health care fraud schemes in history. The scheme revolves around a nationwide brace scam and fraudulent telemedicine companies that led to more than $1.2 billion in losses. CMS announced adverse administrative action against 130 durable medical equipment (DME) companies. There are also a number of physicians named.
The braces included ones for back, shoulder, wrist, and knee braces that were medically unnecessary. Charges were filed against defendants in New Jersey, Florida, Texas, Pennsylvania, South Carolina, and California.
You would know by now if you were “caught up” in this first round. But I’m going to suggest it is a good time to review your use of braces – in outpatient therapy, long term care, skilled nursing, and swing beds – particularly looking for the supporting documentation showing the braces were needed. That documentation should NOT be just in skilled therapy notes. And after the brace is received, there should be documentation on how the resident/patient benefited from it.
If you have any questions regarding this, please email Kerry Dunning at Kerry.dunning@