We may not want to mention any favors from CP/CPOs with Medicare

[AlPikeCP at aol.com]

In a message dated 3/28/2004 8:46:23 PM Central Standard Time, 
CharlesWBriggs at cs.com writes:
The way the deal works is that the government have greatly increased penality 
to all times of health providers (physicians, OT's LPT's, CPO's 
psychologists, clinical social workers, etc). 
However, this goes back to Tony's post as to why....

A 1999 IOG (Office of Inspector )General Report of O&P Fraud and Abuse
concluded the following.

1)  Any supplier with a HCFA provider number, regardless of qualification
can provide and bill Medicare for Orthotic and Prosthetics.

2)  At Least 19% of orthotics provided are medically unnecessary. This
represented $6.4 million in Medicare payments.
Another 5% of orthotic devices are medically questionable, which represent
another $1.5 million

3)  54% of Medicare beneficiaries have questionable billings.

4)  Due to lack of policies ,carrier prepayment checks are limited to
utilization and supplier screens.

Unlike any other professional allied health care or medical service, the
provision of professional O&P is highly clinical and technical service yet,
it is regulated in only 10 of 50 states and has no federal regulation or
price control of health care  devices as they are in most all other health
care arenas.

Identifying "qualified practitioners" and "qualified suppliers" of O&P
health care  with the appropriate professional knowledge and skills can only
be achieved through identifying appropriate recognized education and
mandating licensure models for theses unique allied health care services.

The federal govt.needs to step in a investigate the hold the O&P industry
has on the O&P profession which has resulted in unqualified services being
delivered and reductions and elimination of benefits for  patients requiring
these services.
..
On July 14 , 2003 CMS (Centers of Medicare and Medicaid Services) thru a
Negotiated Rules Committee process was unable to determine O&P provider
qualifications after  9 months of meetings of which the Barr Foundation
participated. These Neg Reg meetings began in October 2002 to provide advice
and make recommendations to the Secretary of Health and Human Services and
reach consensus on rules and regulations for Section 427 of the Benefits
Improvement Act (BIPA).

BIPA was a federal statue passed in 2001 as the result of the fraud and
abuse finding of the OIG report in 1999.
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