Federal Judge Criticizes DMERC

Miami

A federal judge has rebuked a Medicare contractor for paying out $122 million for prosthetic limbs over a four-month period last year in South Florida.

Palmetto GBA, which handles Region C claims, paid for 21,000 artificial legs and arms in the Miami-Dade area, a number that shouldn’t have escaped its notice, according to U.S. District Judge Cecilia M. Altonaga. “Common sense dictates this is an impossibility,” she wrote in a May 10 decision, the Miami Herald reported. According to the newspaper, billings for artificial limbs rose from $2,000 to more than $200,000 a month in the area.

Federal prosecutors have yet to file criminal charges, but have filed a civil suit against 48 suppliers and a billing agency for allegedly submitting false Medicare claims for the prosthetic limbs. Columbia, S.C.-based Palmetto GBA was not included in the lawsuit, but Altonaga had sharp words for the DMERC: “It is unclear why Palmetto GBA is not a subject of the government’s investigation into criminal wrongdoing.”

Palmetto spokeswoman Elizabeth Hammond said catching the scheme at four months was early. “In addition to identifying this issue and actively supporting law enforcement investigation of this case, Palmetto GBA’s scrutiny of orthotics and prosthetic billing in South Florida has resulted in hundreds of millions in program savings,” she told HomeCare.