The National Association for the Advancement of Orthotics and Prosthetics (NAAOP) released a statement about its attendance at a hearing held April 30 by the U.S. House of Representatives Ways and Means Subcommittee on Health to discuss fraud, waste, and abuse in Medicare. According to NAAOP, the effect of the Recovery Audit Contractor (RAC) program and the delay in the Medicare administrative appeals on legitimate O&P providers were not discussed during the hearing.
The subcommittee called three witnesses to discuss action against Medicare fraud. Gloria Jarmon, the deputy inspector general for audit services within the Office of the Inspector General (OIG) for the Department of Health and Human Services, spoke about the need for the Centers for Medicare & Medicaid Services (CMS) to reduce improper payments and improve oversight of contractors. Kathleen King, the director of health for the Government Accountability Office (GAO), spoke about the need for further action at CMS to implement strategies developed by the GAO. Shantanu Agrawal, the new deputy administrator and director of the Center for Program Integrity at CMS, responded to criticism that the agency has not made sufficient progress in fighting Medicare fraud, waste, and abuse. Lawmakers at the hearing said the agency must show greater commitment to tackling fraud. Kevin Brady (R-TX), the subcommittee’s chairman, ended the hearing with a pledge to introduce legislation to address the problem, saying that a recent report revealed that fraud costs Medicare more than $50 billion annually.
For the hearing’s written record, NAAOP and the O&P Alliance will submit testimony to the subcommittee about two legislative proposals that address waste, fraud, and abuse from the perspective of O&P providers. The Medicare Orthotics and Prosthetics Improvement Act of 2013 (House Resolution 3112) would link the ability of providers and suppliers of O&P services to be paid by Medicare to the level of education and training they possess. The bill would implement regulations mandated by a long-standing federal law that prohibits unqualified providers and suppliers from receiving Medicare payment for custom orthotics and prosthetics. NAAOP said that reports suggest that CMS fails to ensure that only licensed providers are paid, and NAAOP’s testimony will highlight how fixing this problem is well within reach as well as long overdue. Draft legislation, the Ensuring Beneficiary Access to Orthotics and Prosthetics Act of 2014, contains options to improve the Medicare administrative appeals process, reform the RAC process, and recognizes O&P practitioners as professional providers of O&P care for purposes of demonstrating medical necessity.