New bill seeks to curb fraudulent payments

Wednesday, September 18, 2013

WASHINGTON – A new bipartisan bill seeks to prevent fraudulent Medicare payments for orthotics and prosthetics (O&P).

Introduced Sept. 17 by Reps. Glenn Thompson, R-Pa., and Mike Thompson, D-Calif., H.R. 3112, the Medicare Orthotics & Prosthetics Improvement Act of 2013, would require CMS to only pay for O&P services provided by accredited or licensed providers.

“When unlicensed and unaccredited providers deliver prosthetic and orthotic services, both Medicare beneficiaries and the American taxpayer are shortchanged,” stated Thompson in a release. “This will protect Medicare beneficiaries by identifying and addressing fraudulent payments, and hold government accountable by reducing fraud and abuse with Medicare.”

Thompson contends that CMS has not enforced existing federal mandates that require a “practitioner” or “supplier” to be certified. That, in turn, has contributed to fraudulent payments, and patient care that is substandard, duplicative or unwarranted.

A report released yesterday found that two-thirds of the $3.62 billion that CMS paid for O&P services for Medicare beneficiaries between 2007-11 went to providers that did not meet licensure and accreditation requirements, according to the report’s author, Allen Dobson of Dobson DaVanzo & Associations, a former director of research at CMS’s predecessor, the Health Care Financing Agency.