AOPA files suit against HHS, Medicare

The American Orthotic and Prosthetic Association (AOPA) filed suit against Health and Human Services and Medicare in the Federal District Court for the District of Columbia, seeking relief from the unfair and unauthorized actions of CMS, primarily actions of its RAC auditors and DME MACs relating to physician documentation requirements.

According to a press release, the suit arises with respect to Medicare actions that began in August 2011 when the Office of Inspector General released a flawed report alleging fraud in the O&P field.

Also in August 2011, through the actions of its DME MAC contractors, CMS circulated a “Dear Physician” letter that dramatically revised the standards by which a prosthetic claim would be judged for reimbursement approval. AOPA believes that these actions violated the federal Administrative Procedure Act and Medicare Act. CMS contractors/auditors then proceeded to apply the new standard retroactively to regain money on claims not involving fraud, but which originated years before CMS contractors devised the new standard.

“Today, AOPA has stated empathically that we will not stand by when government acts inappropriately to threaten either the quality of care we provide to our patients or the economic viability of the small businesses and providers that comprise the orthotics and prosthetics profession,” Thomas F. Kirk, president of AOPA, stated in the release.

To view the complaint, visit

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