Barr Foundation's Blooper of the Week Award to CMS
Tony Barr
Description
Collection
Title:
Barr Foundation's Blooper of the Week Award to CMS
Creator:
Tony Barr
Date:
5/25/2005
Text:
As O&P news in Florida focuses on yet another major recent fraud case of
$122 million paid to unlicensed providers by Medicare , the national media
reports that high risk and convicted sex offenders are recieving Viagra at
tax payers expense thru Medicaid in New York !!
Related ? Both are insults ( Ill be nice and not use any Vitamin V jokes! )
to taxpayers and to O&P patient care and both issues establishes further
proof that CMS isn't minding the store and requires more education on
reimbursement policies !!
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. Do the math ! What a rip besides the risk
patients face recieving comprehensive O&P care from unlicensed providers.
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
< <URL Redacted>
09455--/free-co-factsheet.xhtml> 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 believe that 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 believe that Palmetto is attempting to deflect their own negligence in
paying out $122 million to UNLICENSED providers in a state that requires a
a state license to provide prosthetics, by staging a witch hunt against the
industry as a whole.
As Wade Bader LPO Fla. stated .
I know the level of frustration that the dedicated, honest, legitimate
providers of O and P are feeling in region C. I have been in contact with my
federal representatives as well as the media. I am educating them as to the
reality of the campaign of harassment towards our industry. I have gotten
patients involved, and am doing my share to inspire a grassroots effort to
show the world the impossible position that we as a group, have been
unjustly placed.
I encourage each and every one of you, to make your government officials
and media aware of the problems you are having with Medicare/Palmetto GBA.
This not only effects your own pocket book, it will have a very negative
impact on the patients we are advocating and serve.
I would like to take Wade's wise suggestion one step further and 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..
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. I cant think of a better opportunity than to make this Palmetto GBA a
priority issue at the upcoming O&P Policy Forum.This is a three-day
gathering June 20-22, 2005 of O&P professionals who want to speak directly
with the Capitol Hill legislators making decisions that impact our
profession.
< <URL Redacted>
ents/PolicyForumLetter> Read the Letter from 2005 AOPA President Michael
Hamontree
It 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.
Since Florida is the only ( I believe) and first regulated state within
Region C, this is an excellent opportunity for the profession and industry
to set the record straight and more clearly define the differences of
requirements of providers of DME and those of a licensed O&P professional.
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.
Perhaps the Viagra and Palmetto GBA issues can be linked to the need to
further educate CMS and deliver reform in reimbursement policies provided
needed education that apparently wasn't absorbed by them from 9 months of
non productive Neg Reg meetings.
The blame for both cited examples should be borne on the agency allegedly
overseeing payments of Medicare/Medicaid benefits,....CMS.However the issues
requires education be given to the Florida Board of O&P ,Department of
Health, Florida State Insurance Commissioner, Blue Cross and Blue Shield of
South Carolina and Florida congressional representatives. I wonder how many
private insurance companies are aware that they also may have been defrauded
by these DME's .
If insurance companies are paying for devices from unlicensed facilities are
they not also breaking the law?
This could be a a real opportunity for the profession, patient and taxpayer
to set the record straight.
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
$122 million paid to unlicensed providers by Medicare , the national media
reports that high risk and convicted sex offenders are recieving Viagra at
tax payers expense thru Medicaid in New York !!
Related ? Both are insults ( Ill be nice and not use any Vitamin V jokes! )
to taxpayers and to O&P patient care and both issues establishes further
proof that CMS isn't minding the store and requires more education on
reimbursement policies !!
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. Do the math ! What a rip besides the risk
patients face recieving comprehensive O&P care from unlicensed providers.
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
< <URL Redacted>
09455--/free-co-factsheet.xhtml> 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 believe that 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 believe that Palmetto is attempting to deflect their own negligence in
paying out $122 million to UNLICENSED providers in a state that requires a
a state license to provide prosthetics, by staging a witch hunt against the
industry as a whole.
As Wade Bader LPO Fla. stated .
I know the level of frustration that the dedicated, honest, legitimate
providers of O and P are feeling in region C. I have been in contact with my
federal representatives as well as the media. I am educating them as to the
reality of the campaign of harassment towards our industry. I have gotten
patients involved, and am doing my share to inspire a grassroots effort to
show the world the impossible position that we as a group, have been
unjustly placed.
I encourage each and every one of you, to make your government officials
and media aware of the problems you are having with Medicare/Palmetto GBA.
This not only effects your own pocket book, it will have a very negative
impact on the patients we are advocating and serve.
I would like to take Wade's wise suggestion one step further and 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..
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. I cant think of a better opportunity than to make this Palmetto GBA a
priority issue at the upcoming O&P Policy Forum.This is a three-day
gathering June 20-22, 2005 of O&P professionals who want to speak directly
with the Capitol Hill legislators making decisions that impact our
profession.
< <URL Redacted>
ents/PolicyForumLetter> Read the Letter from 2005 AOPA President Michael
Hamontree
It 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.
Since Florida is the only ( I believe) and first regulated state within
Region C, this is an excellent opportunity for the profession and industry
to set the record straight and more clearly define the differences of
requirements of providers of DME and those of a licensed O&P professional.
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.
Perhaps the Viagra and Palmetto GBA issues can be linked to the need to
further educate CMS and deliver reform in reimbursement policies provided
needed education that apparently wasn't absorbed by them from 9 months of
non productive Neg Reg meetings.
The blame for both cited examples should be borne on the agency allegedly
overseeing payments of Medicare/Medicaid benefits,....CMS.However the issues
requires education be given to the Florida Board of O&P ,Department of
Health, Florida State Insurance Commissioner, Blue Cross and Blue Shield of
South Carolina and Florida congressional representatives. I wonder how many
private insurance companies are aware that they also may have been defrauded
by these DME's .
If insurance companies are paying for devices from unlicensed facilities are
they not also breaking the law?
This could be a a real opportunity for the profession, patient and taxpayer
to set the record straight.
********************
To unsubscribe, send a message to: <Email Address Redacted> with
the words UNSUB OANDP-L in the body of the
message.
If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
Paul E. Prusakowski,CPO at <Email Address Redacted>
OANDP-L is a forum for the discussion of topics
related to Orthotics and Prosthetics.
Public commercial postings are forbidden. Responses to inquiries
should not be sent to the entire oandp-l list. Professional credentials
or affiliations should be used in all communications.
Citation
Tony Barr, “Barr Foundation's Blooper of the Week Award to CMS,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/224791.
