The O&P Alliance wrote a letter to U.S. Department of Health & Human Services (HHS) Inspector General, Daniel R. Levinson on May 23, expressing its concern over and offering solutions to the recent increase in Medicare-enrolled physicians and physician groups who have made arrangements with other enrolled suppliers in order to bill for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and specifically custom O&P devices, from their own physician-owned laboratories (POLs). The Alliance letter stated that at many medical business meetings there are entities that market the concept of physician-owned O&P laboratories and self-referrals to those laboratories based on the potential profitability. Further, with the exception of certain prefabricated off-the-shelf orthoses or supply items, allowing referring physicians to provide other types of O&P care opens the door to overutilization, potentially suspect medical judgment, unfair competition, and increased costs to the Medicare program and its beneficiaries.
The Alliance letter also pointed out previously published guidance from the Office of Inspector General (OIG), which “made it clear that an opportunity for a referring physician to earn a profit, including through an investment in an entity for which the physician generates business (e.g., through referrals to the business) could constitute illegal remuneration under the anti-kickback statute.” And while the OIG guidance was directed at physician-owned distributors (PODs), the Alliance wants that guidance to be applied equally to physician ownership of O&P laboratories. The letter further stated: “that physicians are exempt from the O&P accreditation requirement and quality standards creates a circumstance that could result in the physician opting to replace devices that otherwise would be repaired by an O&P facility that has the necessary equipment and laboratory to effect such repairs.”
All five members of the O&P Alliance chief elected officers signed the letter on behalf of the American Academy of Orthotists and Prosthetists (the Academy), the American Board for Certification in Orthotics, Prosthetics and Pedorthics (ABC), the American Orthotic & Prosthetic Association (AOPA), the Board of Certification/Accreditation, International (BOC), and the National Association for the Advancement of Ortho tics and Prosthetics (NAAOP).
To read the letter, visit www.aopanet.org, navigate to access the Legislative and Regulatory pull-down menu and click on Regulatory News.
