Heritage Medical Equipment, LLC

Medicare Fraud in Houston

Endurance Iyamu, 47, of Houston owned and operated a DME company in Lafayette, LA called Skyline Medical.  This alleged criminal falsely billed Medicare for ankle braces, knee braces, and braces for the neck, shoulder, and elbow.  Skyline Medical operates in Lafayette, the Medicare beneficiaries Iyamu was receiving payment for were all in Houston.  The orthopedic braces were never delivered.  Iyamu also billed Medicare for braces and kits delivered to deceased patients.     

Iyamu was indicted on 3 counts of aggravated identity theft, 11 counts of health care fraud, and one count of conspiracy to commit health care fraud.  If convicted he can get 10 years in prison and a $250K fine for the conspiracy charge and an additional 10 years and $250K fines for each count of the health care fraud.  

Good.  Throw the book at him.  White collar crime is more harmful to our society than street crime.  Iyamu deserves hard time in an overcrowded cell.   

Iyamu defrauded Medicare from 2007 to 2009.  He alledgedly billed our government for claims of $1.2 million and received $663K in payments.  DME is a drop in the bucket when it comes to Medicare.  Our government needs to invest more capital in policing our current healthcare system.  Iyamu is just one of many.  There's probably enough money to give every US citizen health coverage that currently doesn't have it just with the dollars our government loses in fradulent Medicare activities. 

Hanger Announces Five Acquisitions

Hanger Orthopedic Group, Inc announced last week that they are acquiring orthotic and prosthetic facilities in California, New York, Illinois, Texas, Washington, and Virginia.  Ortho-Medical Products, US Orthotics & Prosthetics, MK Prosthetics & Orthotics, Rainier Surgical Inc, Team Post-Op Inc, and BioConcepts will add to Hanger's $20.2 Million of annual net revenue.

The President and CEO of Hanger, Thomas Kirk, said about the acquisitions, "We are extremely pleased to welcome these talented professionals to the Hanger team. They bring an outstanding reputation for superior patient care and will add value to our core O&P business. These acquisitions were financed with internally generated cash flows and will be accretive to earnings after completion of the initial integration period. We continued to evaluate additional opportunities to acquire patient care centers that meet our criteria."

 

New Medicare Bill - H.R. 1958

The text for Medicare's new Bill - H.R. 1958 is now available.  To refresh your memories this is the bill that could put a hurting on stock and bill companies.  If passed only certified practitioners will be able to bill medicare for orthotics and prosthetics.    

Text for H.R. 1958

Please read the proposed bill and comment below.  Your feedback is important!  What level of certification do you think is appropriate?

 

Students Make a Prosthetic Leg for $25.00.

 

Tortoise Hot Rod

  Please let me introduce you to Gamera, the 12-year old African Sulcata tortoise. Check him and his prosthetic foot out!

Orthopets Comes Through

Naki'o is a puppy who was found frozen in a Nebraska puddle.  His paws were amputated due to frostbite.  Christie Tomlinson, a veterinary technician, adopted Naki'o and raised enough money to buy two prosthetic paws from a company called Orthopets.  

Naki'o's story has appeared on many television news broadcasts and is all over the internet.  But what isn't being reported is how wonderful Orthopets is.  Orthopets donated two of the four legs that allows Naki'o to be an active puppy.  They also built the prosthetic puppy limbs.

OrthoPets was founded by Martin Kaufmann in 2003.   He recognized a need and brought his background in human Orthotics and Prosthetics into the animal healthcare industry.  The need came into light when a family dog, Walt, suffered a stroke.  Walt lost the ability to use his front leg.  Kaufmann was surprised at the vets recommended amputation. Coming from the human practice, Martin’s first thought was to use an Orthotic Device to position the limb so that Walt could ambulate normally.  And that's how Orthopets came into existence.

Well done Martin!  Keep up the great work.

 

 

 

Criminal Simone Ball is Convicted!

 Enjoy Your New Home Simone!

 

Simone Ball is owner of Preferred Plus Medical Supply in Houston Texas.  The 24 year old felon recently pled guilty to one count of conspiracy to commit health care fraud.  Ball's scheme to defraud Medicare stole $654,227 from her friends, family, and other taxpayers.  

Court documents show that Ball obtained and maintained a valid Medicare provider number in order to submit claims for durable medical equipment and orthotics.  Ball's plan to steal from the government involved fraudulently billing for "arthritis kits" that contained knee braces, heating pads, and other orthotic devices.

Ball faces a maximum penalty of 10 years in prison.  Hopefully Texas throws the book at her.  

The U.S. Attorney's Office Medicare Fraud Strike Force is responsible for uncovering Ball's criminal activities.  The Medicare Fraud Strike Force has obtained indictments in over 1000 cases in which Medicare was falsely billed for more than $2.3 billion.

Enjoy prison Simone.  You deserve everything coming your way.  

Delaware Fights for Prosthetic Parity

House Bill 76 is heading to the Delaware State Senate after being unanimously passed by the House last week.  This bill requires health insurance companies to reimburse for artificial limbs at the same rate as the federal government.  Delaware is looking to join the 11 other states with prosthetic parity laws on the books.

House Bill 76 is sponsored by Democrats Helene Keeley, Debra Heffernan, and Gerald Brady.

Brady recently said, "passage of a prosthetic parity bill is necessary, because while some insurers will cover 80  percent or more of the cost of prosthetics and orthotics at any time, others allow a person 1 prosthetic or orthotic for a lifetime."   

Texas Cease and Desist - Who's Next?

 

I'm not sure which manufacturer is next on the Texas Board of Orthotics & Prosthetics Cease and Desist hit list, but I have a couple of recommendations.

First is Ossur.  This icelandic orthotic and prosthetic manufacturer currently has a business plan that is centered around fitting patients with their products and billing for services.  They can only survive if they cut the O&P professional out of the equation.  Why do you want to buy a $16K microprocessor knee from a company that is actively trying to take the "O" out of O&P?  These folks want your orthopedic patients and your prosthetic business.  Don't give them both.  Make Ossur choose.

The second is Biomet.  Biomet acquired EBI several years ago.  EBI was once the leading stock and bill company in the industry.  Biomet is a self-proclaimed leader in the orthopaedic market.  Their stock and bill company hires unlicensed and uncertified people to fit braces in the offices of orthopedic surgeons and hospitals.  Few companies have done more to devalue the O&P industry than this conglomerate.  Athletic Trainers are not trained to fit orthotics and prosthetics.  Why are they doing so?  

Go get em Texas.  Please show my friends and colleagues in the Northeast how to stand up for themselves.

Get your guns up Lubbock!  Yeah, Shoe - I'm thinking of you.

 

Texas Pride. Bledsoe Gets a Cease And Desist Too!

 

"Texas has yet to learn submission to any oppression, come from what source it may."  Sam Houston

Like Don Joy Orthopedics, Bledsoe was hit with a Cease and Desist from the Texas Board of Orthotics & Prosthetics on March 15th.      

The complaint reads, "Our office has been informed that you may be providing services as an orthotist or prosthetist in the state of Texas without being currently licensed by the Texas Department of State Health Services...."

The complaint continues, "you are hereby instructed to Cease and Desist from providing services and/or advertising as an orthotist and/or prosthetist.  Failure to comply with this cease and desist order may result in further department action against you."

The complaint references the Texas Occupation Code Section 821.21 Professional Standard and Disciplinary Provisions. (d) Unprofessional or unethical conduct.  A license, registration, or facility accreditation may be denied, revoked, suspended, probated, reprimanded, or have an administrative or civil penalty imposed for unprofessional or unethical conduct, as defined in subsections (b) and (c) of this section.  Other action which may cause a license, registration or facility accreditation to be denied, not renewed, revoked, suspended, or an administrative or civil penalty to be imposed include, but are not limited to: (4) engaging in conduct that state, federal, or local law prohibits;

This isn't the first time Bledsoe has been in trouble.  Bledsoe was sued by now out-of-business Generation II for infringing on their Unloader Knee Brace patents.  If you are a certified orthotist ask yourself why do business with a manufacturer that takes your patients and makes a living off other people's ideas?