Keith CPO BOC ,
What, no meaningful licensure designation?
I believe your suggestion below regarding the feasibility of filing a class
action suit against CMS/Palmetto/Region C Medicare is not only feasible but
absolutely necessary.
Palmetto GBA realizes that they made some serious blunders here, and could
ultimately lose their contract with Medicare.
Is not Blue Cross and Blue Shield accountable as well?
I cant think of a better opportunity than to make this Palmetto GBA a
priority issue.
Well paid lobbyists representing primarily industry interests, have been far
to long negligent in representing the interests of the profession,…. your
profession.
Up until now the Academy has been negligent in delegating legislative issues
to AOPA.
CMS violated Florida state law in not confirming their contractor’s
providers credentials and were legally qualified and duly licensed to do so
in a regulated state..
A offensive and another effort to educate CMS by a coalition of professional
and patient advocacy groups supporting the cause of state regulation aimed
at CMS and a federal level and need of establishing regulation in every
state.
This Florida fraud case of Palmetto GBA came from the payment for of $122
million for 21,000 prosthetic devices over 4 months to several companies in
the Fort Lauderdale Florida area.
“The Miami Herald has recently published an article about the case, where
Federal Judge Altonaga has questioned the negligence and culpability of
Palmetto GBA in the case.” Palmetto GBA is subsidiary of Blue Cross & Blue
Shield of South Carolina, and oversees Medicare benefits for people in 16 US
states, most of which are in the Southeast and Midwest, as well as in Puerto
Rico and the US Virgin Islands. Palmetto GBA’s services include the
processing and payment of health insurance claims, customer service support,
and payment safeguarding services that seek to eliminate Medicare abuse,
fraud, and waste. Palmetto GBA is one of the largest Medicare contractors in
the United States — processing more than 125 million Medicare recipient
claims annually.”
The O and P folks that are accepting Medicare assignment in Region C, have
seen a campaign of harassment and intimidation over the past year.
I would like to see a coalition bring the case, of Palmetto GBA improper
billing and non compliance to state regulation law in having licensed
providers, against CMS and Blue Cross Blue Shield , whom funded Palmetto
GBA..
A class action law suit will further defines the need of separation of DME
from O&P to better assure patient protection.
This is a fraud case offers excellent timing and purpose that could benefit
all of the profession.
It’s a real opportunity !
Certainly responsibility falls on CMS whom simply didn’t do their homework
(they never do) in verifying the providers required certain state
credentials and they Palmetto GBA (CMS contractors) were not in compliance
with Florida law regarding qualifications of providers of O&P.
If other insurance companies are paying for devices from unlicensed
facilities are they not also breaking the law?
James Fenton LPO in Florida could be very help full in filing the suit and
is quoted below.
“The blame should be borne on the agency allegedly overseeing payments of
Medicare/Medicaid benefits,CMS.
The months in question are probably those in which some 474 shoulder
disartics were billed (4th qtr,2004) I think we’ve already discussed that
one.”
“Palmetto GBA is the contractor that ALLOWED this fraud to happen. They
have successfully dumped the suspicion on us because “P&O is substantially
the same as DME.” They have used their screwed up statistics to make us out
as thieves.
If the OIG would wake up and ask some hard questions, he/she just might find
that those fine folks at Palmetto GBA are DOLTS. They’re using those
statistics to cover their —es rather than to solve their internal
problem.”
“The Federal Government (read you and I) would save a —-pot full of money
by getting rid of Palmetto and allowing us to provide services; REAL, not
fraudulent.”
“For those of you who are willing to put the blame on DME: the Palmetto GBA
sight, http://exclusions.oig.hhs.gov/bygclass2.html, will confirm your
suspicions. Listed are the names of 1622 DME companies and one CPO. To be
completely fair, one of the names in the DME section was (he is deceased) a
CPO.”
Keith, I’ve personally been in the trenches since 1995 and my father (also
an amputee and amputee advocate) before me since 1980 in supporting state
licensure laws and proper reimbursements.
Just for some historical background, on my personal motivation, in 1980,
AOPA and the Academy passed a corporate resolution to draft and support a
“model” licensure bill for every state provided my father, a influential
senator and amputee from Illinois ,could stop the Medicare/Medicaid cutbacks
in O&P in the USA.
He delivered 25 years ago and they did not. How do you like it now ?
I’m driven to reform this industry into a legitimate health care profession
to benefit patients in recieving qualified O&P services and benefits.
Recently CMS made the announcement below .
CMS Delays Implementation of ‘Qualified Provider’ Provisions
The “qualified provider” rules that were supposed to be implemented in all
states by the Centers for Medicare & Medicaid Services (CMS) starting on
July 1 will now only be implemented in states that have O&P licensure,
attendees at the O&P Policy Forum learned. The Policy Forum, a grassroots
initiative organized and led by the American Orthotic and Prosthetic
Association (AOPA) June 20-22, involved O&P professionals visiting
Congressmen and women to promote the O&P legislative perspective.
As a avid and long time supporter of providing the much needed professional
legitimacy to O&P practitioners as licensed health care providers , I
applaud the CMS decision to restrict reimbursement to only licensed
practitioners and suppliers.
http://www.oandp.com/edge/issues/articles/NEWS_2005-06-28_02.asp
I believe the class action lawsuit is the last alternative we have to
surface the issue.
It must be provider and patient driven to be truly effective.
Are you listening ACA ?
What about all the whiners in the 5,000 member “profession”.
Now is your chance to excel and at the same time save your “profession”.
Count me in !
Tony Barr
