In 2002, an OIG report found that Medicare inappropriately reimbursed podiatrists for Routine Foot Care Services that were found to be medically unnecessary and insufficiently documented. Since the OIG had not reviewed podiatry services since that report back in 2002, an audit was conducted to determine whether these compliance issues continued to exist during the subsequent audit period, 2019 and 2020. The audit examined whether podiatrists’ claims for Routine Foot Care Services related to a covered systemic condition complied with Medicare’s requirements. Of the 100 claims that were sampled, 49 claims for Routine Foot Care Services related to a covered systemic condition did not comply with Medicare requirements. As a result of the audit, the OIG opined that CMS’s oversight may not have been sufficient to prevent improper payments. The OIG estimated that of the $18.2 million paid by Medicare during the audit period, approximately $4.4 million did not comply with Medicare’s requirements.
The OIG recommends that CMS work with the seven Medicare Administrative Contractors to determine whether additional oversight is necessary to prevent payments for Routine Foot Care Services that did not comply with Medicare requirements, which amounted to an estimated $4.4 million dollars during the audit period. When compared to the $39.6 million dollars that were improperly paid during the audit that was performed for Evaluation and Management Services, this certainly appears like a “drop in the bucket.” However, the bottom line of the OIG is to eliminate fraud and waste and that is their ultimate goal.
This audit was performed based upon the fact that Medicare does not generally cover Routine Foot Care Services unless the patient has a covered systemic medical condition that increases the risk of infection or the loss of a limb if the services are not performed by a qualified medical professional, a podiatrist. The objective was to determine whether podiatrists’ claims for Routine Foot Care Services related to a systemic condition complied with Medicare’s requirements. Examples of systemic diseases that cover Routine Foot Care Services when appropriately documented are diabetes, multiple sclerosis and peripheral artery disease.
Most of the Medicare Administrative Contractors have LCDs or Local Coverage Determinations and the associated articles regarding the billing and coding of Routine Foot Care. These are the rules and regulations that need to be followed. For those Medicare Administrative Contractors that do not have an LCD for Routine Foot Care, this does not let the practitioners in those jurisdictions off the hook. There are National Coverage Determinations and the associated articles for the coding and billing of Routine Foot Care that are easily accessible. Highlighted issues are insufficiently documented services, incorrectly coded services and medically unnecessary services.
On October 23, 2005, Dr. Mehmet Oz, the Administrator for the Centers for Medicare and Medicaid Services sent a correspondence to Carla J. Lewis the Acting Deputy Inspector General for Audit Services. Office of the Inspector General. The Subject was the following: Office of Inspector General (OIG) Draft Report: Podiatrists’ Claims for Routine Foot Care Services Did Not Comply With Medicare Requirements (A-09-22-03011).
The OIG recommends that the Centers for Medicare and Medicaid Services work with the Medicare Administrative Contractors to analyze RFC claims related to systemic conditions billed by podiatrists – specifically claims billed with E/M services – to determine whether additional oversight (eg. guidance, education, medical reviews, and/or provider internal audits) is necessary to prevent improper payments, which amounted to an estimated $4,425,822 for the audit period.
“At Risk,” Routine Foot Care is the “bread and butter” of the podiatry profession. Why put it at risk?
Michael G. Warshaw, DPM, CPC
Source of information: HHS Office of Inspector General
Report Highlights
December 2025/A-09-22-03011
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