A recent OIG report, "Questionable Billing by Suppliers of Lower Limb Prostheses," asserts that Medicare inappropriately paid $43 million in 2009 for lower limb prostheses that did not meet local Medicare coverage requirements. Medicare paid an additional $61 million for prosthetic claims for beneficiaries that had no claim from a referring physician for the preceding 5 years, raising questions about whether a physician ever evaluated the beneficiary and whether these devices were medically necessary. The OIG also found that 267 suppliers of lower limb prostheses had questionable billing (e.g., frequent billing for unusual combinations of prostheses or for beneficiaries who had no history of a missing limb). CMS concurred with the OIG's recommendations that the agency: implement additional claims processing edits; strengthen monitoring of billing for lower limb prostheses; implement requirements for a face-to-face encounter to establish the beneficiary’s need for prostheses, revise the requirements in the local coverage determination; and take appropriate action with regard to suppliers with questionable billing. CMS disagreed with a recommendation that the agency enhance screening for currently-enrolled suppliers of lower limb prostheses, since CMS contends it has sufficient tools in place to allow for increased scrutiny of existing DMEPOS suppliers.