bypassing orthotists
Monroe Prosthetics & Orthotics
Description
Collection
Title:
bypassing orthotists
Creator:
Monroe Prosthetics & Orthotics
Date:
2/13/2006
Text:
Recently, Our Facility was contacted to provide a custom AFO for a hospital in-patient. On contacting the insurance company to obtain a Prior Auth, we were informed By Cigna that Don-Joy was contracted to provide all orthotic services, and if the patient chose to work with us it would be at the out of contract fee screen. The patient declined our sevices. I was told, D.J. subsequently had the local rep go out, scan the leg and deliver an AFO.
If DJ is indeed obtaining 3rd party contracts and billing insurance companies (including Medicare?), then they fall under the same rules and guidelines that we all do. If that is the case and they are also selling straight to the public at below Medicare fees, it strikes me as fraudulent billing practices. (Wonder what a whistle blowers reward would be on that nut?)
Robert P. Agard, CPO
If DJ is indeed obtaining 3rd party contracts and billing insurance companies (including Medicare?), then they fall under the same rules and guidelines that we all do. If that is the case and they are also selling straight to the public at below Medicare fees, it strikes me as fraudulent billing practices. (Wonder what a whistle blowers reward would be on that nut?)
Robert P. Agard, CPO
Citation
Monroe Prosthetics & Orthotics, “bypassing orthotists,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/226140.
