Year: 2019

American Orthotic and Prosthetic Association urges action during annual Policy Forum

Washington, DC – The American Orthotic and Prosthetic Association (AOPA), will ask Congress to act on proposals that will improve the orthotic and prosthetic (O&P) profession and the lives of the patients it serves when they convene in Washington DC this week.

During the 2019 AOPA Policy Forum (May 7 and 8), more than 100 O&P providers, patients and stakeholders from 26 states, will urge members of Congress to support crucial legislation and fund programs that restore the lives of those living with limb loss or impairment.

When they meet with members of Congress, O&P advocates will encourage lawmakers to support and enact legislation that helps address the recent Depart of Justice indictments against 24 defendants responsible for losses to Medicare through fraudulent schemes involving lead generation marketing to deliver medically unnecessary or unwanted orthoses. To do this, legislation would need to distinguish O&P patient care encounters from durable medical equipment, re-assert the congressional definition of “minimal self adjustment” for off the shelf orthotics, and exempt licensed and certified O&P providers from competitive bid contracts.

They will also ask them to enact the Wounded Warrior Workforce Enhancement Act which was introduced by Senators Dick Durbin (D IL) and Chris Murphy (D-CT), and Representative Matt Cartwright (D PA) last week. This bill improves O&P care for wounded warriors by ensuring an adequate workforce through grants provided to O&P education programs.

“Together we will ask for common sense solutions that are focused on patients,” said Eve Lee AOPA’s Executive Director. “Whether it’s improving patient access to quality O&P care, defending patients against fraudulent practices, or shoring up the future workforce, we will ask for legislation that affords, safe, effective, patient-centered orthotic and prosthetic care.”

ALEXANDRIA, VA – On March 28, 2019, the American Orthotic and Prosthetic Association (AOPA) released a statement strongly criticizing the use of lead generation marketing to deliver orthotic devices to patients covered by Medicare or other insurances. This practice puts patients at risk as it does not provide clinical care by a qualified orthotic professional and could lead to providing medically unnecessary orthoses with no instruction on the proper fitting, care, or use.

Yesterday, less than two weeks after this, the U.S. Department of Justice (DOJ) announced multiple indictments against 24 individuals responsible for more than $1.2 billion in losses to the Medicare program through fraudulent schemes involving the use of lead generation marketing to deliver orthoses that were not medically necessary or not wanted by the beneficiary. Simultaneously, the Centers for Medicare and Medicaid Services (CMS) announced the immediate suspension of Medicare payments to 130 Medicare enrolled Durable Medical Equipment suppliers suspected of participating in the scheme and responsible for more than $1.7 billion in Medicare claims and more than $900 million in Medicare reimbursement.

AOPA is highly encouraged by both the DOJ indictments and the administrative action taken by CMS. We are hopeful that this sweeping action will drive this criminally negligent activity out of the orthotic and prosthetic marketplace. AOPA first expressed concern about potential fraud and abuse involving off-the-shelf (OTS) orthoses when CMS identified a complete set of OTS codes that, according to its own policy, required little to no fitting by properly certified or licensed orthotic professionals to deliver and bill to Medicare. We have continued to voice our concern at every opportunity.

Most recently, AOPA has pursued legislation that will ensure that Medicare patients continue to have access to clinically appropriate orthotic care delivered by properly educated, certified and/or licensed professionals. AOPA, with the support of its O&P Alliance partners, is preparing legislation which contains several provisions that would further guarantee that criminal elements such as those uncovered by DOJ will no longer be able to use OTS orthoses to generate illegal profits through exploitation of the Medicare program and its beneficiaries. AOPA is currently meeting with key members of Congress to discuss potential sponsorship. The hope is for the bill to be introduced prior to the 2019 AOPA Policy Forum taking place May 7-8, 2019 in Washington, DC. During the Forum, AOPA members will meet with members of Congress to encourage them to
take action that protects patients.

ALEXANDRIA, VA – The American Orthotic & Prosthetic Association (AOPA), announced that it is strongly opposed to the model for delivery of orthoses that relies on what is known as lead generation marketing to identify and recruit potential patients for treatment with orthoses.

Lead generation marketing uses broad stroke advertising such as television ads, websites, and social media to encourage potential patients to contact a call center which then provides the “leads” to a select group of physician referral sources and medical equipment suppliers who facilitate the delivery of one or more orthoses to the patient, often without the patient ever seeing the referring physician or the supplier of the device. This model of delivery is of great concern to AOPA as it does not include any fitting of the orthoses by health care professionals such as a certified and/or licensed orthotist. It also includes no patient education on the proper care and use of the orthosis, no follow up care to ensure that the orthosis is providing its intended benefit and lacks any kind of patient evaluation to determine the clinical appropriateness of the prescribed orthosis. This model of delivery is not one that is interested in the provision of clinically appropriate orthoses by properly trained, educated, and certified or licensed orthotic professionals. It is simply an opportunity for unscrupulous providers to take advantage of loopholes in the Medicare claims processing system to generate as much revenue as possible without regard to the medical need of the orthoses they are marketing. In addition, lead generation marketing of orthoses typically relies on a limited number of physician referral sources who often have no relationship with the patient prior to their brief consultation, usually over the telephone, upon referral from the lead generation company. These physicians are often fully aware of their role in this process and are often compensated by the lead marketing company on a per prescription basis. This practice is clearly not in the best interest of Medicare beneficiaries.

Recent reports published by the Department of Health and Human Services Office of Inspector General (OIG) have confirmed that there have been increased instances of fraud and abuse involving knee and spinal orthoses. AOPA believes that lead generation marketing strategies may be a significant contributor to this increase in fraud and abuse investigations. The orthoses that have been highlighted in the OIG reports have shown significant increases in utilization since the first appearance of the online and televised advertisements produced by lead generating marketing companies. It is not a coincidence that the largest increases in Medicare spending for orthoses represent the high cost orthoses that are being marketed to unsuspecting Medicare beneficiaries.

AOPA firmly believes that Medicare beneficiaries deserve to receive the highest quality, most clinically appropriate orthotic care available and that it is in the best interest of the Medicare program to ensure that the delivery of all orthoses must be coordinated through the physician or practitioner who is treating the patient’s orthopedic condition and a properly trained and educated orthotic provider, such as a certified or licensed orthotist. Alternative models, such as those that use lead generation marketing, will continue to facilitate increased fraud and abuse, unnecessary costs and utilization, andn the delivery of ill-fitting orthoses that may not be medically necessary without any clinical care, patient follow up, or patient education.

Questions? Please contact Joe McTernan, at 571/431-0811 or jmcternan@AOPAnet.org.