PT ACTIVITIES IN FLORIDA/ ILLEGAL OR NOT

PT ACTIVITIES IN FLORIDA/ ILLEGAL OR NOT

Anthony T. Barr

6/23/2003

> Jeffery, I have cc your below inquiry to:
>
> Andrew A. Guccione, PT, PhD, FAPTA
> Senior Vice President - Practice and Research
> American Physical Therapy Association
> e: <Email Address Redacted>
>
> whom maybe helpful in providing you and the other subscribers of the
O&P
> Listserve, with a better understanding of the compliance or lack thereof
,
> to the Florida Statue. I am confident the national PT organization would
> have interest in addressing your concerns and nowledge of any suspected
> illegal
> activities of their members.
>
> You also have not only have the option but the responsibility required by
> the statue to report suspected unlicensed activities of providers of O&P
> services in the state of Florida.
> See <URL Redacted>
>
> Tony Barr
> Barr Foundation
> www.oandp.com/barr
>
> ----- Original Message -----
> From: < <Email Address Redacted> >
> To: < <Email Address Redacted> >
> Sent: Friday, June 20, 2003 1:11 PM
> Subject: [OANDP-L] ILLEGAL OR NOT
>
>
> > We have O & P licensure in the state of Florida and I recently had a
> > disturbing conversation with a parent about a physical therapist casting
> for an AFO.
> > Cascade DAFO company billed the insurance company with L1960 as the base
> code.
> > When I called the therapist, she stated I am not making or billing for
> the
> > brace I only cast and fit these braces She also stated that she does
> this
> > during therapy sessions. DOUBLE BILLING? Evaluating, Casting, Fitting
> and a 3
> > month follow-up period is included in all L codes. I believe this
therapy
> > practice to be double billing and violating the licensure law enforced
by
> the
> > Florida dept. of health.
> > When I spoke to Cascade Dafo, They informed me that they use a special
> > modifier to these L codes stating their fee is excluding fitting and
> adjustments
> > and also send a letter stating this with the HCFA bill. I asked the
> Cascade
> > Dafo representative what this special modifier is and where I can find
> info on
> > it. Their response was that they did a lot research and that I should
do
> the
> > same. If the insurance commission and the department of insurance has
> OK'd a
> > special modifier it would be public knowledge. I have never heard of
> these
> > modifiers. Since when can L codes be stripped down to not include
fitting
> and
> > follow up adjustments? Can you imagine how much these insurence
companies
> are
> > getting ripped off when P. T. charges for their time for casting,
fitting
> and
> > adjusting braces.
> > This particular patient was sent to me after the brace the P. T.
casted,
> > Cascade made and P. T. fit caused the patient to walk worse than prior
to
> the
> > brace. Patient needed an adjustment to an old brace and the P. T. told
> the h
> > usband to trim the AFO with scissors. Ouch! What a lawyer could do with
> this
> > case.
> > 1. Not licensed O & P professional
> > 2. Billing? All parties involved can be held liable.
> > Is Cascade Dafo knowingly helping P.T.'s do what I understand to be
> ILLEGAL??
> >
> > Oh, The P. T. also stated that Cascade Dafo will not bill for medicaid
> > patients. I wonder Why?????
> >
> > Jeffrey Price, CPO
> >
>