Association Blasts Medicare for Paying Unlicensed Prosthetics Providers

The American Orthotic and Prosthetic Association has a beef with the Centers for Medicare and Medicaid Services: It says the agency is allowing uncertified medical providers to collect government payments for the devices, despite federal and state law.

The Centers for Medicaid and Medicare Services (CMS) continues to allow unlicensed providers of orthotics and prosthetics (O&P) services to apply for and collect federal payments, despite regulations in at least 15 states prohibiting it, according to a report from the American Orthotic and Prosthetic Association (AOPA).

A report in Modern Healthcare details the controversy, which came to a head when AOPA released a study last month [PDF] indicating that the number of Medicaid patients receiving equipment from providers who aren’t certified had not changed, despite congressional and regulatory efforts in 2000 and 2005 to reduce the number of claims paid to such vendors.

“Taxpayers are seeing billions of dollars go to unlicensed providers in direct violation of what Congress has mandated,” AOPA President Thomas Kirk said in a statement announcing the report. The association represents the interests of some 2,000 businesses that build and sell orthopedic braces and artificial limbs to patients.

Kirk said the findings come at a time when certified prosthetics and orthotics providers have complained about the government’s stringent auditing process.

“As unlicensed firms continue to have federal funds lavished on them in violation of the law, the reputable, licensed, and legal operators in the industry are being subjected to a regulatory crackdown that is so severe that AOPA has been forced to go to court to challenge it,” he said.

15 states

The American Board for Certification in Orthotics, Prosthetics, and Pedorthics reports that 15 states currently have certification laws: Alabama, Arkansas, Florida, Georgia,  Illinois, Iowa, Kentucky, Ohio, Oklahoma, New Jersey, Pennsylvania, Rhode Island, Tennessee, Texas, and Washington. In an analysis of Medicare bills from three of those states—Florida, Illinois, and Texas—spanning 2007 to 2011, the AOPA study found that 68 percent of orthotic services and roughly 16 percent of prosthetic services were supplied by vendors without certification.

A report [PDF] from the U.S. Department of Health and Human Services’ inspector general issued a year ago said CMS had failed to take the necessary steps to enforce rules implemented by Congress as part of the Benefits Improvement and Protection Act of 2000, nor had it followed guidelines it established in 2005 as part of an agency transmittal letter.

“Allowing noncertified personnel to provide these services…could lead to fraud and abuse in O&P services, as well as expose patients who received these services to inappropriate or substandard care,” the AOPA report notes.

CMS Administrator Marilyn Tavenner noted in a letter that accompanied the 2012 inspector general report that a set of rules to meet the standards laid out in the 2000 law were under development, but none have been implemented, according to the Modern Healthcare report.

bill in the Works

Renewed attempts to curb Medicare fraud are underway. The Medicare Orthotics and Prosthetics Improvement Act of 2013— introduced Rep. Glenn Thompson (R-PA) and cosponsored by four members, including Rep. Mike Thompson (D-CA)—would require CMS to reimburse only accredited and licensed orthotics and prosthetics providers. The bill was referred to a House committee in September.

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


Emma Beck

By Emma Beck

Emma Beck is a contributor to Associations Now. MORE

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