AOPA criticizes ‘unscrupulous’ providers

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Thursday, March 28, 2019

ALEXANDRIA, Va. – The American Orthotic & Prosthetic Association is “strongly opposed” to lead-generation marketing for orthoses, a business practice that it says is responsible for an increase in fraud and abuse, the association said in a statement today.

Lead-generation marketing uses television, website and social media channels to encourage people to contact a call center that then provides “leads” to physician referral sources and medical equipment providers. People receive one or more orthoses, often without ever seeing a physician or the supplier.

“This model of delivery is not one that is interested in the provision of clinically appropriate orthoses by properly trained, educated and certified or licensed orthotic professionals,” said AOPA. “It is simply an opportunity for unscrupulous providers to take advantage of loopholes in the Medicare claims processing system to generate as much revenue as possible without regard to the medical need of the orthoses they are marketing.”

Recent reports from the Office of Inspector General have highlighted increased instances of fraud and abuse for knee and back braces. CMS recently announced it would include the devices in the next round of competitive bidding.