Re: Prime Fare/Opportunity for Licensees of Region C
Tony Barr
Description
Collection
Title:
Re: Prime Fare/Opportunity for Licensees of Region C
Creator:
Tony Barr
Date:
6/14/2005
Text:
The proposed Region C Medical Director meeting represents a opportunity for
the O&P profession.
Why not take the opportunity to raise the issue of CMS providing
reimbursement to unlicensed provider(s) of comprehensive O&P services
Palmetto GBA (a subsidiary of Blue Cross Blue Shield of South Carolina) in a
state that is regulated ?
Funny with all the talk, conference calls and such, since the issue of
Palmetto surfaced last month, I have not read one thing about Blue Cross
Blue Shield's role !
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.
Do you think AOPA is going to effectively slam and go up against either Blue
Cross Blue Shield and CMS about this ?
This is a provider issue and its the responsibility and it is the law for
all of the licensees of this state to expose unlicensed activities.
Taxpayers pay the freight and they need to be properly informed.
The Florida O&P License Board and Department of Health, Florida Insurance
Commissioner , to expose the atrocity of a provider ,a subcontractor of
Blue Cross Blue Shield, recieving payment by CMS (the federal government)
for the delivery of O&P. At the same time you make the statement for the
distinction of the differences of O&P and DME to CMS.
* Orthotics and Prosthetics are NOT Durable Medical Equipment and should not
be lumped in and treated as such. Due to physiologic/neurological/pathologic
changes within a human being, an orthosis and/or prosthesis will not always
fit and function appropriately for five or more years.
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? How about CMS in
authorizing payment to unlicensed providers?
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.
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..
This is a fraud case offers excellent timing and purpose that could benefit
all of the profession.
Since I believe Florida is the only ( I believe Tenn passed a licensure law
and Georgia is working on it) 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.
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
,Florida 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.
Has ACA gone on record in opposition to this issue ??
Will the leadership of ACA join the Barr Foundation in writing a position
statement re: the issue and attend the Region C meeting to protect the
interests of the patient ?
An alliance between patient and licensed profession can make a powerful
statement.
If this doesn't work consider a lawsuit suit to surface the issue or you can
do what most of you do, and sit on your hands and allow the industry
interests to continue you call the shots..It matter not if you win a lawsuit
but it can surely create public awareness.
It does not take allot of intellect to understand that your profession has
been and remains in a crisis.
Anthony T. Barr
_____
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of James Fenton
Sent: Monday, June 13, 2005 9:14 PM
To: <Email Address Redacted>
Subject: [OANDP-L] Prime Fare
It appears that the Region C Medical Director is afraid there will be too
many hard questions and has limited them to the pre-submitted kind. Sounds
like a dodge to me. I'll bet she'll shower the attendees with statistics
about how people other than O&P bilked them out of millions and then go on
to say that they now have it under control; by dumping on us.
It ought to be a great presentation, pay close attention. Meanwhile, maybe
someone will have the stones to presubmit: Of the thousands of hearings
that you have caused to occur, what is the percentage that was won by O&P
practitioners? I'll bet they don't gather that particular statistic. Of
course: What percentage of cases heard by an ALJ have been won by P&O
practitioners?
Or, how about: Why do we have to pay for your incompetence? She dodged that
one altogether in Hollywood at the AOPA meeting, but I say give her a second
chance, she was probably just nervous. Certainly, she has to have something
to say on the subject.
Then again, maybe it's just me.
Jim Fenton, LPO
the O&P profession.
Why not take the opportunity to raise the issue of CMS providing
reimbursement to unlicensed provider(s) of comprehensive O&P services
Palmetto GBA (a subsidiary of Blue Cross Blue Shield of South Carolina) in a
state that is regulated ?
Funny with all the talk, conference calls and such, since the issue of
Palmetto surfaced last month, I have not read one thing about Blue Cross
Blue Shield's role !
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.
Do you think AOPA is going to effectively slam and go up against either Blue
Cross Blue Shield and CMS about this ?
This is a provider issue and its the responsibility and it is the law for
all of the licensees of this state to expose unlicensed activities.
Taxpayers pay the freight and they need to be properly informed.
The Florida O&P License Board and Department of Health, Florida Insurance
Commissioner , to expose the atrocity of a provider ,a subcontractor of
Blue Cross Blue Shield, recieving payment by CMS (the federal government)
for the delivery of O&P. At the same time you make the statement for the
distinction of the differences of O&P and DME to CMS.
* Orthotics and Prosthetics are NOT Durable Medical Equipment and should not
be lumped in and treated as such. Due to physiologic/neurological/pathologic
changes within a human being, an orthosis and/or prosthesis will not always
fit and function appropriately for five or more years.
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? How about CMS in
authorizing payment to unlicensed providers?
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.
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..
This is a fraud case offers excellent timing and purpose that could benefit
all of the profession.
Since I believe Florida is the only ( I believe Tenn passed a licensure law
and Georgia is working on it) 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.
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
,Florida 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.
Has ACA gone on record in opposition to this issue ??
Will the leadership of ACA join the Barr Foundation in writing a position
statement re: the issue and attend the Region C meeting to protect the
interests of the patient ?
An alliance between patient and licensed profession can make a powerful
statement.
If this doesn't work consider a lawsuit suit to surface the issue or you can
do what most of you do, and sit on your hands and allow the industry
interests to continue you call the shots..It matter not if you win a lawsuit
but it can surely create public awareness.
It does not take allot of intellect to understand that your profession has
been and remains in a crisis.
Anthony T. Barr
_____
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of James Fenton
Sent: Monday, June 13, 2005 9:14 PM
To: <Email Address Redacted>
Subject: [OANDP-L] Prime Fare
It appears that the Region C Medical Director is afraid there will be too
many hard questions and has limited them to the pre-submitted kind. Sounds
like a dodge to me. I'll bet she'll shower the attendees with statistics
about how people other than O&P bilked them out of millions and then go on
to say that they now have it under control; by dumping on us.
It ought to be a great presentation, pay close attention. Meanwhile, maybe
someone will have the stones to presubmit: Of the thousands of hearings
that you have caused to occur, what is the percentage that was won by O&P
practitioners? I'll bet they don't gather that particular statistic. Of
course: What percentage of cases heard by an ALJ have been won by P&O
practitioners?
Or, how about: Why do we have to pay for your incompetence? She dodged that
one altogether in Hollywood at the AOPA meeting, but I say give her a second
chance, she was probably just nervous. Certainly, she has to have something
to say on the subject.
Then again, maybe it's just me.
Jim Fenton, LPO
Citation
Tony Barr, “Re: Prime Fare/Opportunity for Licensees of Region C,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/225026.
