The American Orthotic & Prosthetic Association (AOPA) has filed suit against the U.S. Department of Health and Human Services (HHS), Medicare in the Federal District Court for the District of Columbia. AOPA said the suit is seeking relief from the unfair and unauthorized actions of the Centers for Medicare & Medicaid Services (CMS), primarily via actions of its Recovery Audit Contractor (RAC) auditors and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) relating to physician documentation requirements.
“Today, AOPA has stated…that we will not stand by when government acts inappropriately to threaten either the quality of care we provide to our patients or the economic viability of the small businesses and providers that comprise the orthotics and prosthetics profession,” said Thomas F. Kirk, AOPA president.
AOPA’s suit arises with respect to Medicare actions that began in August 2011 when the HHS Office of Inspector General (OIG) released a report alleging fraud in the O&P industry. According to a written statement from AOPA, the report misunderstood that patients don’t go to their physicians when their prostheses are not working properly; misunderstood that it is not unusual that most Medicare amputees may not see the referring physician who first prescribed their prosthetic care because that physician is commonly the surgeon who amputated their limb; created extensive confusion about whether individuals with bilateral amputations should have both prostheses on a single claim or two separate claims; leapt to conclusions of fraud because claims costs had increased with a fixed number of Medicare amputee beneficiaries while failing to recognize that Iraq-Afghanistan wars had prompted a “quantum leap in technology,” and a related incremental increase in unit cost, which together with CMS-approved O&P fee schedule increases, “after years of ‘freeze,'” had driven per capita increases; and failed to track, as required by BIPA 427, whether or not care providers were, or were not, qualified providers under federal law.
Additionally, AOPA alleges that CMS was in violation of the federal Administrative Procedure Act and the Medicare Act, when, in August 2011, it revised the standards by which a prosthetic claim would be judged for reimbursement approval by circulating a “Dear Physician” letter. Please note that the relief sought in the lawsuit is only on behalf of AOPA members.
To read the full complaint, visit the AOPA website.
