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Memo to CMS: Stop paying unlicensed providers

Memo to CMS: Stop paying unlicensed providers

There's a difference between providing high-quality O&P care in a facility and operating out of garage, say providers who support a bill that would level the playing field.

“It is hard to compete when you've got a lot of controls in place to ensure that you're putting out a quality product,” said James Rogers, owner of PPS Orthotic and Prosthetic Services in Chattanooga, Tenn. “There are some folks out there that don't really have a facility. Having a physical location where patients can come for follow-up repairs and maintenance is very important.”

The Medicare Orthotics & Prosthetics Improvement Act of 2013, introduced Sept. 17, would require Medicare to pay only licensed providers.

Licensure laws governing O&P vary by state. In Florida, long considered a hotbed of fraud for all types of home medical equipment, provider Jim Newberry says he's practically on a first-name basis with inspectors from the National Supplier Clearinghouse.

“In 2012, I got hit 11 times and, so far, four times in 2013,” said Newberry, CEO and director of orthotic patient management at Mahnke's Orthotics-Prosthetics in Oakland Park, Fla. “They are doing inspections, but they also need to find out of there's a licensed individual (on staff).”

While both Rogers and Newberry say they welcome any efforts to curb fraud, they say Medicare should already be on top of these issues.

“If Medicare wouldn't pay them, we wouldn't have to worry about them,” said Newberry.


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