Re: Potential Diabetic Shoe "Scam" in New York

Re: Potential Diabetic Shoe "Scam" in New York

Jim Rogers, CPO

11/11/2003

My reply is to the list-serve because I think it is high time we as a profession, and the PFA as well, address the providers who use the therapeutic shoe bill as a conduit for shoddy care and quick payoffs. The combination of aggressive business practices and marketing, easy access to patients, and a vulnerable population make for a travesty in health care.

I have been approached by Medicare providers who wish to have me deliver shoes to patients for them for a $50 fee. To get around the OIG regulations, they call this a marketing charge. They leave brochures in pharmacies, with unsuspecting physician groups and offer thinly disguised kick-backs as incentive for referrals. They operate with impunity and even boast of their financial success when trying to lure you into their network. As I travel to area nursing homes, I witness ill-fitting foot wear and orthoses with jagged edges trimmed in haste in order to get to the next room. Most often the cheapest shoe and orthotic combination is offered without consideration for the individual needs of the patient. Sometimes the billing is done from another state, and patients have no idea who is providing their care. The 20% is disregarded routinely to avoid suspicion. This fact is sometimes marketed to unsuspecting rehab departments as an indication of the practitioner's priority!
  of quality patient care over profitability. Give me a break! I had no idea how pervasive this problem is until recently. I've even seen these jokers unloading shoes from the trunks of their cars at a patient's home! The patient assumed their doctor had sent them.

CMS needs to be made aware of this by organizations representing providers of quality care, but also individual practitioners who witness these events. Call the CMS Fraud unit and report what you know. These actions represent one of the most blatant misuses of our tax dollars and only serve to erode the confidence of patients and their families.

    --
Reply from Jim Rogers, CPO, FAAOP
> This message is being posted for Bob Bangham, CO, LO - he had some
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> Dear Membership,
>
> This evening, 11/10/03 I got a distressing call from a friend of mine. His
> son living in New York has been invited to take a 3 hour course on Wednesday
> 11/12/03 which will then have him trained to go door to door and sell
> Diabetic Shoes & Inserts, his Dad say's he is offered $65.00 a customer to
> make these sales.
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> I feel this is fraudulent and have told Dad & son this, but need some
> information documenting the illegality of this action, any idea's.
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> I'm told this man has initiated this practice in Houston, TX and as a Texas
> practitioner feel that our licensure law is designed to have only CO',
> C'Ped's & Physicians be allowed to provide these services in Texas.
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> The obviously major payor of these services would be Medicare and this also
> would appear to be Medicare fraud, since the biller is not the person
> providing the patient contact and the patient contact person has no
> competency, in my opinion.
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> Please, respond ASAP.
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> Thanks,
>
> Bob Bangham, C.O., L.O.
> Corpus Christi, Texas
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