Unlicensed providers receive illegal payments for OandP devices

According to a recent report released by the American Orthotic & Prosthetic Association, CMS has failed to stop the illegal practice of paying unlicensed providers for orthotic and prosthetic services provided to Medicare beneficiaries. The report also states CMS has incorrectly told Congress that such illegal payments have ceased and is now engaged in a regulatory assault on legitimate licensed industry providers.

From 2007 to 2011, a significant percentage of the $3.62 billion CMS paid for orthotic and prosthetic services for Medicare beneficiaries went to unlicensed providers, as well as those who failed to meet the accreditation requirement legislated by Congress in 2000, providing billions of dollars to providers Congress specifically intended to exclude from eligibility for payments.

“Taxpayers are seeing billions of dollars go to unlicensed providers in direct violation of what Congress has mandated,” Thomas F. Kirk, PhD, president of the American Orthotic & Prosthetic Association (AOPA), stated during a teleconference. “The legitimate industry is being subjected to a misdirected and entirely arbitrary crackdown via government-sanctioned bounty hunters playing by their own set of rules. And even as unlicensed firms continue to have federal funds lavished on them in violation of the law, the reputable, licensed and legal operators in the industry are being subjected to a regulatory crackdown that is so severe that AOPA has been forced to go to court to challenge it in order to avoid seeing the orthotic and prosthetic industry so enmeshed in pointless government challenges, audits and other costly and time-consuming red tape that it is unable to meet the urgent needs of patients.”

In an effort to strengthen Medicare O&P benefits by reducing fraud and abuse, improve health care quality and reduce Medicare spending, Rep. Glenn Thompson (R-Pa.) and Rep. Mike Thompson (D-Ca.) will introduce the Medicare Orthotics and Prosthetics Improvement Act of 2013. The act will consist of three reforms:

  • CMS will be prohibited from making any payment for orthoses and prostheses to a provider who is not appropriately licensed in a state that requires licensure;
  • Practitioners will be required in states without licensure requirements to be accredited;
  • Eligibility for Medicare payments will be linked to the qualifications of the provider and the complexity of the device needed.

“This combination of much needed reforms will keep fraudulent providers out of the O&P arena so that only legitimate practitioners will be paid for serving Medicare beneficiaries,” Glenn Thompson stated during the event. “By linking Medicare payments to the qualifications of the provider and the complexity of the patients’ needs of the device, these reforms will ensure that beneficiaries receive high quality care so that they do not have to receive duplicate items and duplicate services, which come at duplicate costs.”

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