Bill seeks to curb O&P fraud

WASHINGTON - A bill that would require Medicare to pay only licensed providers for orthotics and prosthetics (O&P) is a proverbial hat trick, say stakeholders.

“It would save money for the government, it would cut back on fraud, and it would aid patients by assuring that a higher quality of care is available to them,” said Tom Fise, executive director of the American Orthotics and Prosthetics Association (AOPA).

The Medicare Orthotics & Prosthetics Improvement Act of 2013, H.R. 3112, was introduced Sept. 17 by Reps. Glenn Thompson, R-Pa., and Mike Thompson, D-Calif.

A report by Dobson DaVanzo & Associates, released the same day the bill was dropped, 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.

“When unlicensed and unaccredited providers deliver prosthetic and orthotic services, both Medicare beneficiaries and the American taxpayer are shortchanged,” stated Thompson in a press release.

That's not to say all unlicensed providers are necessarily fraudulent, says Fise. There may be cases, for example, where they are not meeting their state requirements. Even in those cases, however, it's time for these providers to get on the stick and get compliant, he says.

CMS is making attempts to reduce fraud for O&P by developing a clinical template for physicians. But those attempts, at least so far, have only shown the agency's lack of understanding for how products and services are provided, stakeholders say.

The template would just make life difficult for legitimate providers and result in an increase in audits by recovery audit contractors (RACs), they fear.

“There's no fraud being found by the RACs,” said Fise. “This is all about getting paperwork right."