O&P stakeholders take next steps to preserve access

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Friday, April 26, 2019

WASHINGTON – O&P stakeholders plan to use a recent massive fraud takedown involving medically unnecessary knee and back braces to advance upcoming legislation.

The American Orthotic & Prosthetic Association has been trying to get legislation passed for several years that would curb fraud and abuse, and improve access to clinically appropriate care for beneficiaries.

“It’s great to see this first wave of charges,” said Todd Eagen, president of the Orthotic Prosthetic Group of America. “I believe there will be some positive changes as a result of this.”

Earlier this month, the federal government announced it had charged 24 defendants, including telemedicine company executives, DME company owners and licensed medical professionals, in the $1.2 billion scheme, dubbed “Operation Brace Yourself.”

AOPA plans to have legislation introduced in time for the 2019 AOPA Policy Forum, May 7-8 in Washington, D.C. One provision would restrict the use of drop shipping for Medicare-reimbursed braces.

“They deliver braces without ever actually interacting with the patient,” said Joe McTernan, director of coding and reimbursement services, education and programming for AOPA. “The patients didn’t need or want the braces, but were pulled in by some slick advertising, where they dial a number and the next thing, five braces are on their doorstep, all billed to Medicare.”

Stakeholders believe the timing of the fraud takedown and CMS’s decision to include off-the-shelf orthotics in Round 2021 of the competitive bidding program will make for a compelling argument on the Hill for preserving access to clinically appropriate care.

“From what we are hearing nationwide, the majority of traditional O&P providers will not participate or submit bids,” said Eagen. “We are in the process of educating them right now. It’s a huge learning curve.”

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