Re: PT ACTIVITIES IN FLORIDA/ ILLEGAL OR NOT

Re: PT ACTIVITIES IN FLORIDA/ ILLEGAL OR NOT

Anthony T. Barr

6/22/2003

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
>