Heritage Medical Equipment, LLC

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."   

H.R. 1958 is a Step in the Right Direction

When Congress approved the Benefits Improvement And Protection Act of 2000 (BIPA), Orthotic & Prosthetic suppliers were required to be certified in order to receive reimbursement for Medicare services.  However this never happened.  Medicare and Medicaid patients to this day still continue to be susceptible to substandard care and the industry is still vulnerable to fraudulent payments.  H.R. 1958, the Medicare Orthotics and Prosthetics Improvement Act of 2011 is designed to remedy the shortfalls of prior legislation.

Representative Shelly Berkley (D-NV) and Glenn Thompson (R-PA) are the pair responsible for introducing this much needed fix.

 "Our legislation seeks to improve care for patients with orthotic and prosthetic devices and to ensure they are receiving treatment from those who are best suited to address their particular medical needs.  At the same time, our bill will save money by cracking down and ending fraudulent payments through Medicare," Berkley recently commented. 

How will H.R. 1958 strengthen BIPA?

1.  H.R. 1958 will protect certified O&P practitioners by enforcing BIPA provisions.  BIPA dictated that O&P practitioners must be accredited or certified to receive Medicare payments.  This provision has never been implemented.  The new legislation will enforce the existing legislation.

2.  H.R. 1958 will reduce unnecessary federal expenditures to unqualified suppliers and reduce unnecessary beneficiary co-pays.  This is important because under the Medicare Improvements for Patients and Provider Act (MIPPA) which was recently passed many providers became exempt from accreditation.  

3.  H.R. 1958 will require CMS to report to Congress on its efforts to reduce fraud and abuse.  This provision stems from the 2005 Medicare requirement that contractors only pay O&P suppliers that are licensed in states that require licenses.  Though the requirement is on the books nothing has ever been put in place to enforce the provision.   

Stock & Bill Beware!

It's good to see Republicans and Democrats working together.  Especially when they are combining forces that will hopefully put an end to stock and bill programs.  Representatives Glenn Thompson (R-PA) and Shelley Berkley (D-NV) recently introduced legislation to diminish Medicare fraud in O&P and improve the level of O&P care.  H.R. 1958, the Medicare Orthotics & Prosthetics Improvement Act of 2011 is intended to achieve these goals.

Glenn Thompson said, " Fraud and abuse contributes not only to rising costs, but also harms patients, particularly when medically necessary devices are provided without expert care or without necessity.  We need to collectively look to create savings by combating waste, fraud and abuse.  This legislation will enhance  patient care and ensure that Medicare fraud is addressed, particularly when the fiscal solvency of the program is in question.

The new legislation will require that only certified practitioners who are accredited or licensed be eligible to receive Medicare reimbursement.  This is bad news for stock & bill companies. 

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?  

 

 

Don't Mess With Texas. DJO Ordered to Cease and Desist!

"I done drew the line.  Just like the Alamo.  You're either on one side of the line or the other."  Bum Phillips

It's about time someone in the O&P community acted to protect their profession.  And I'm not surprised that someone is from Texas.  I'm located in the northeast and I've watched for years as practitioners twiddle their thumbs and complain about manufacturers encroaching on their businesses.  In New York a license is required to cut hair, but not to fit knee braces and prosthetics. 

Get up with Texas!

On March 15th the Texas Board of Orthotics & Prosthetics slapped DJO with a Cease And Desist Order.

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;

I hope Texas doesn't let DJO buy their way out of this.  And I can only hope this first jab leads to a knock-out.  It's about time unqualified people stop pretending their certified professionals.

 

 

CMS Final Ruling - Section 424.57(d)

Section 424.57(d) adds a new paragraph to the regulations that if a DMEPOS supplier is convicted of a felony or involved in adverse legal actions that CMS or the NSC can establish an "overpayment" from the date of conviction.  

They believe this is necessary because some DMEPOS suppliers fail to report convictions to the NSC.  This new provision gives CMS the authority to assess and collect all overpayments from the time of the reportable event.

CMS DMEPOS Final Ruling - Rules and Regulations

 

CMS Final Ruling - Section 424.57(c)(31)

 

Effective September 27th, 2010 the final ruling from CMS will regulate DMEPOS suppliers and their ability to establish and maintain billing privileges.  

Section 424.57(c)(31) specifies that a DMEPOS supplier could not have IRS or state tax delinquencies.  Being convicted of tax evasion or the filing of a  tax lien can also mean a suspension or ban of privileges.

CMS DMEPOS Final Ruling - Rules and Regulations

 

CMS Final Ruling - Section 424.57(c)(30)

 

Section 424.57(c)(30) proposes a new standard that requires DMEPOS suppliers to be open a minimum of 30 hours per week.  

"Given that Medicare beneficiaries may not be able to find transportation during limited operating hours, the DMEPOS supplier must be open and available for periods long enough for beneficiaries to readily access their facility."   

CMS DMEPOS Final Ruling - Rules and Regulations

CMS Final Ruling - Section 424.57(c)(29)

The final ruling from CMS will become effective on September 27th, 2010.  This ruling regards DMEPOS suppliers' ability to establish and maintain billing privileges for Medicare.   

Section 424.57(c)(29) states that a, "supplier is prohibited from sharing a practice location with another Medicare supplier."

CMS believes that allowing a supplier to, "commingle its practice location with another DMEPOS supplier effectively limits the ability of CMS and NSC to ensure each DMEPOS supplier meets all of the supplier standards."

This is bad news for stock and bill companies.  Rumors state that Biomet (formerly EBI) is already making plans to stop billing for Medicare patients in the majority of their facilities.  Will Don Joy follow suit?  

CMS DMEPOS Final Ruling - Rules and Regulations