Prosthetic bill: 'Common sense'

Monday, April 23, 2012

WASHINGTON – A bill that aims to tackle fraud and abuse in orthotics and prosthetics (O&P) could change the way some providers do business.

The Medicare Orthotics and Prosthetics Improvement Act of 2012, S. 2125, was introduced in February by Sen. Ron Wyden, D-Ore. The bill seeks to curb fraud and abuse by: prohibiting Medicare payments to unlicensed providers in states that require O&P licensure; and implementing and enforcing accreditation standards for O&P identical to standards adopted by the Department of Veterans Affairs.

“I think it’s common sense,” said Tom Fise, executive director of the American Orthotic & Prosthetic Association (AOPA). “Fraud is a problem and it’s a problem that costs money, but it also is debilitating to the spirit of patients who have enough problems without having to have fraud issues beset them as well.”

Accreditation, says Fise, would be another impediment to people looking to make a quick hit on Medicare.

The bill would also link payment for O&P to the complexity of the device and the qualification of the provider. To do that, the bill would create five O&P categories, ranging from basic off-the-shelf orthotics to custom fabricated limbs.

“(Right now) a person whose sole skill is as a mastectomy fitter can bill Medicare for a custom fabricated limb and be paid,” said Fise. “We’d be better off if there was some training or qualification on those complex codes.”

Patients would be better off, too, say stakeholders.

“Some unqualified individuals and suppliers are providing orthotic and prosthetic related services that they are not certified, licensed or accredited to provide,” said Claudia Zacharias, president and CEO of the Board of Certification/Accreditation, International. “We have seen this issue in our accreditation survey processes, the mail-order provision of certain devices and in various reports from the Department of Justice.”

If a patient receives a device that does not meet his/her needs, the patient and the insurer, including Medicare, may end up paying twice if the device needs to be replaced, Zacharias said.