Pacific Medical, Inc., Received Some Unallowable Medicare Payments for Orthotic Braces

From January 1, 2015, through March 31, 2017 (audit period), Pacific Medical, Inc., which is located in Tracy, California, did not always comply with Medicare requirements when billing for selected orthotic braces (i.e., back, knee, and ankle-foot braces). For 89 of the 100 sampled claims, Pacific Medical complied with the requirements. However, for the remaining 11 claims, it did not comply with the requirements. Specifically, Pacific Medical billed for orthotic braces that were not medically necessary for nine claims and could not provide medical records for two claims.