Re: Medicare & new prostheses
Kim L. Ruhl CPO
Description
Collection
Title:
Re: Medicare & new prostheses
Creator:
Kim L. Ruhl CPO
Date:
11/15/2005
Text:
Stephan,
Your predicament illustrates a level of Medicare's malfeasance rampant in all DMERC regions. This cancer continues to grow, confound, and suffocate this profession. Unless we can collectively establish effective protocol to address such deficiencies, we will not survive as a profession with our dignity intact.
Far too many conscientious practitioners are being held hostage by a perplexing moral dilemma. Do the right thing for the patient by taking huge monetary loss or suffer the heartbreak of financial expediency saying there is nothing I can do. As professionals this is an untenable position which is happening all too often and we must find a way to stop it.
Professional organizations such as AOPA, AAOP, ABC, or BOC have failed to forcefully address this issue for fear of alienating certain dues paying constituency. Some such as ABC claim to have a cannon of ethics, but reality reveals a toothless watch dog that is neither ready, willing, nor able to take appropriate action or sanctions.
Licensure is a valiant attempt and a step in the right direction at the state level, but it is presently limited and feeble and has yet to universally address and resolve federal problems.
The Center for Medicare Services is the key to solving this problem as they are the cause. In 1997 congress legislated the Balance Budget Act into law, requiring Medicare to achieve full compliance. This mandate ultimately resulted in a poorly reasoned and deliberate 180 degree shift in Medicare policy protocol. Medicare rescinded kickback enforcement in an attempt to deregulate the profession and privatize. Medicare was warned by the OIG against implementing such a reckless policy noting that implementation of discounting would lead to fraud, abuse, and increased frequency of usage.
The goal of deregulation is the destabilization of the market place. Throwing the market into economic free fall should stimulate competition and lower prices or so the thinking goes. Destabilization has been chiefly facilitated by proxy under Medicare's tacit and watchful eye, by ruthless and aggressive third party payers. Third party discounts (kickbacks) are used as an extortionary wedge to divide and plunder P & O providers. The rational and goal of privatization of Medicare is curbing costs and increasing efficiency. However the Medicare objective has backfired creating record budgetary expenditures of unprecedented scale. The reason for this can be found in Medicare's failure to keep the playing field level by penalizing offenders.
The result, legitimate P & O profits have eroded to critical levels causing even ethical providers to severely compromise treatment. Many compromised practices take on an it's just business, anything goes, and survival of the fittest attitude as ethics fly out the window replaced by sheer desperation. By perusing these reckless tactics Medicare officials have abdicated their fiduciary responsibility to the patient and the taxpayer, and have mitigated an unprecedented level of suffering and fraud.
There is nothing inherently wrong with competition or capitalism but referees are necessary for the game to proceed fairly. Accountability and compliance is a responsibility we all must eventually face, because lack of accountability carries with it such a devastating price tag. Until we recognize that people need to be held accountable for their actions, patients and practitioners will continue to needlessly suffer, and exploitation and fraud will remain the norm.
Not the best of news, but I am convinced that at least knowing what the problem is, constitutes a part of the solution.
Sincerely,
Kim L. Ruhl CPO
Dear List
A patient contacted me who was fitted for a prosthesis 3 months ago by
another company. Evaluation revealed unacceptable fit of socket. Patient
does not want to go back to the original provider due to poor service. Does
anybody from Medicare Region A have experience in dealing with such
situation? Questions: I'd rather fit the patient with a new prosthesis vs a
new socket for liability reasons, since I did not make the original
prosthesis. Will Medicare pay? If not, then the only solution might be to
replace the socket. In this situation do you address the liability issue in
any way?
Thank you.
Stephan R. Manucharian, CP
Orthopedic Arts
Brooklyn, NY 11201
718-858-2400; Fax: 718-858-9258;
<Email Address Redacted>
Your predicament illustrates a level of Medicare's malfeasance rampant in all DMERC regions. This cancer continues to grow, confound, and suffocate this profession. Unless we can collectively establish effective protocol to address such deficiencies, we will not survive as a profession with our dignity intact.
Far too many conscientious practitioners are being held hostage by a perplexing moral dilemma. Do the right thing for the patient by taking huge monetary loss or suffer the heartbreak of financial expediency saying there is nothing I can do. As professionals this is an untenable position which is happening all too often and we must find a way to stop it.
Professional organizations such as AOPA, AAOP, ABC, or BOC have failed to forcefully address this issue for fear of alienating certain dues paying constituency. Some such as ABC claim to have a cannon of ethics, but reality reveals a toothless watch dog that is neither ready, willing, nor able to take appropriate action or sanctions.
Licensure is a valiant attempt and a step in the right direction at the state level, but it is presently limited and feeble and has yet to universally address and resolve federal problems.
The Center for Medicare Services is the key to solving this problem as they are the cause. In 1997 congress legislated the Balance Budget Act into law, requiring Medicare to achieve full compliance. This mandate ultimately resulted in a poorly reasoned and deliberate 180 degree shift in Medicare policy protocol. Medicare rescinded kickback enforcement in an attempt to deregulate the profession and privatize. Medicare was warned by the OIG against implementing such a reckless policy noting that implementation of discounting would lead to fraud, abuse, and increased frequency of usage.
The goal of deregulation is the destabilization of the market place. Throwing the market into economic free fall should stimulate competition and lower prices or so the thinking goes. Destabilization has been chiefly facilitated by proxy under Medicare's tacit and watchful eye, by ruthless and aggressive third party payers. Third party discounts (kickbacks) are used as an extortionary wedge to divide and plunder P & O providers. The rational and goal of privatization of Medicare is curbing costs and increasing efficiency. However the Medicare objective has backfired creating record budgetary expenditures of unprecedented scale. The reason for this can be found in Medicare's failure to keep the playing field level by penalizing offenders.
The result, legitimate P & O profits have eroded to critical levels causing even ethical providers to severely compromise treatment. Many compromised practices take on an it's just business, anything goes, and survival of the fittest attitude as ethics fly out the window replaced by sheer desperation. By perusing these reckless tactics Medicare officials have abdicated their fiduciary responsibility to the patient and the taxpayer, and have mitigated an unprecedented level of suffering and fraud.
There is nothing inherently wrong with competition or capitalism but referees are necessary for the game to proceed fairly. Accountability and compliance is a responsibility we all must eventually face, because lack of accountability carries with it such a devastating price tag. Until we recognize that people need to be held accountable for their actions, patients and practitioners will continue to needlessly suffer, and exploitation and fraud will remain the norm.
Not the best of news, but I am convinced that at least knowing what the problem is, constitutes a part of the solution.
Sincerely,
Kim L. Ruhl CPO
Dear List
A patient contacted me who was fitted for a prosthesis 3 months ago by
another company. Evaluation revealed unacceptable fit of socket. Patient
does not want to go back to the original provider due to poor service. Does
anybody from Medicare Region A have experience in dealing with such
situation? Questions: I'd rather fit the patient with a new prosthesis vs a
new socket for liability reasons, since I did not make the original
prosthesis. Will Medicare pay? If not, then the only solution might be to
replace the socket. In this situation do you address the liability issue in
any way?
Thank you.
Stephan R. Manucharian, CP
Orthopedic Arts
Brooklyn, NY 11201
718-858-2400; Fax: 718-858-9258;
<Email Address Redacted>
Citation
Kim L. Ruhl CPO, “Re: Medicare & new prostheses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/225720.
