Protections would be established for Medicare beneficiaries receiving prosthetic and orthotic services, and unlicensed providers would be targeted, under legislation recently introduced by U.S. Rep. Glenn “GT” Thompson (R-PA).
The Medicare Orthotics and Prosthetics Improvement Act, H.R. 2599, would ensure that only licensed and accredited prosthetic and orthotics providers are reimbursed by Medicare. Those devices would also be distinguished from durable medical equipment (DME) under the bill by establishing orthotists and prosthetists as Medicare providers.
“As a former recreational therapist and licensed nursing home administrator, I understand the challenges that those who have suffered serious injuries are facing,” Thompson said. “It is our duty to ensure these individuals are not being subjected to further hardships and financial burdens as a result of fraud in the O&P sector.”
“The Medicare Orthotics and Prosthetics Improvement Act of 2017 will strengthen the quality of care while reducing costs within the Medicare program,” Thompson said, who introduced the bipartisan bill with U.S. Rep. Mike Thompson (D-CA).
A provision of the Benefits Improvement and Protection Act (BIPA) of 2000 stipulates that suppliers and practitioners of certain orthotic and prosthetic services must be certified in order to receive Medicare payments. Because the Centers for Medicare and Medicaid Services (CMS) has not enforced that provision, however, unlicensed providers can receive fraudulent payments, sometimes for providing substandard or nonexistent care.
In addition to requiring orthotics and prosthetics providers to be certified in order to receive payments, H.R. 2599 would also stipulate that notes taken by orthotics and prosthetics practitioners should be considered a legitimate component of a patient’s medical record.