Dear Editor:
The federal government has identified Florida as a magnet for Medicare fraud and abuse. But Floridians requiring the use of orthotic and prosthetic services (artificial limbs and orthopedic braces) are at risk of receiving sub-standard care, and professionals who have completed the necessary education, training and other requirements to become Medicare-qualified and state-licensed are losing millions of dollars of business to unqualified and unlicensed suppliers, due to regulations that are not being enforced by Medicare.
CMS, the federal agency that administers the Medicare program, issued Change Request (CR) 3959 in August 2005, requiring Medicare to deny payment of prosthetics and orthotics if the services are provided by a supplier that does not meet the state licensing statute. Florida has a state licensing law for prosthetists and orthotists that is designed to ensure that these services are provided by qualified professionals with a state license to treat orthotic and prosthetic patients.
Local newspapers are full of stories of fraud and abuse in the Medicare program, with a particular emphasis on Dade County. And yet, CMS has failed to implement its own rules to prohibit this fraud from occurring. In fact, in September of 2005, the Government Accountability Office issued a report calling for more stringent Medicare supplier enrollment standards and enhanced screening to reduce fraud among suppliers. The report estimated that a full 10 percent, or $900 million, of Medicare claims paid during 2004 for durable medical equipment and orthotic and prosthetic items and services, was “inappropriate.”
CMS admits that the current rules on orthotic and prosthetic billing are not being enforced by Medicare. CR 3959 is supposed to be in effect today for prosthetic and orthotic services and devices. With the huge problem that Medicare fraud represents in Florida and throughout the country, why is it not currently being enforced?
The State of Florida needs to use its power to validate the licensure status of individual Medicare suppliers who provide orthotic and prosthetic care to patients and investigate those who fail to comply. The State should also pressure CMS to finally implement its own common sense rules that would have prevented inappropriate payment of millions in past taxpayer dollars.
Sincerely,
Michael R. Rieth
Certified and Licensed Prosthetist/Orthotist
St. Petersburg Limb & Brace
St. Petersburg, Fla.
(727) 321-3900