Federal Reports

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.

Nearly all Medicare Part B payments to a chiropractor in Queens, New York, did not comply with Medicare requirements. Specifically, 95 of 100 sample claims for which the chiropractor received Medicare Part B reimbursement did not comply with Medicare requirements. These improper payments occurred because the chiropractor did not have any policies and procedures to ensure that chiropractic services provided to Medicare beneficiaries were medically necessary and sufficiently documented.

Atlantis Health Care Group of Puerto Rico, Inc., claimed dialysis services that did not comply with Medicare requirements during all 100 beneficiary-months that we sampled. (A beneficiary-month was defined as all dialysis services provided to a Medicare beneficiary during 1 calendar month.) For example, Atlantis claimed reimbursement for dialysis services for which (1) beneficiaries' medical information was not adequately supported, (2) plans of care or comprehensive assessments did not comply with Medicare requirements, and (3) physicians' orders did not meet Medicare requirements.