Prosthetics fraud claims billions in Medicare dollars | On Call

September 19, 2013 by Arezu Sarvestani

Unlicensed providers are collecting billions in Medicare funds for orthotics and prosthetics while "overkill" regulation strangles legitimate providers, according to a report from the American Orthotic Prosthetic Assn.

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MASSDEVICE ON CALL — Researchers say a "significant percent" of the $3.62 billion that the Centers for Medicare & Medicaid spent on orthotics and prosthetics between 2007-2011 went to unlicensed providers. Agency attempts to stem the fraud have only served to strangle legitimate providers in red tape, according to the American Orthotic Prosthetic Assn.

Billions of Medicare dollars went to "providers who Congress specifically intended to exclude from eligibility for payments," according to an AOPA report.

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The group further maintained that Medicare has been hushing up the problem, telling Congress incorrectly that the illegal payments have stopped.

"Taxpayers are seeing billions of dollars go to unlicensed providers in direct violation of what Congress has mandated," AOPA president Thomas Kirk said in prepared remarks. "The legitimate industry is being subjected to a misdirected and entirely arbitrary crackdown via government-sanctioned bounty hunters playing by their own set of rules."

A bipartisan team of House Representatives have teamed up to address the problem, and they've introduced legislation that aims to "reduce fraud, protect patients and save money in Medicare's treatment of a very important and sensitive group of patients," according to a statement by former CMS administrator Thomas Scully. "Keeping out fraudulent providers in the first place is a better way to fight Medicare fraud and abuse instead of ongoing pay and chase methods."