FW: [OANDP-L] Local prosthetist medicare rip off?

FW: [OANDP-L] Local prosthetist medicare rip off?

Tony Barr

10/5/2006

Although Hime's response to the dilemma Phillipe Cartaya described, may have
been professional as Sam stated ,however the fact is this abuse by some
providers recommending and charging insurers and patients for costly high
tech prosthetic components for low activity amputees, is rampant.

My last experience, personally witnessing seeing nine amputee in Nashville
Tennessee at a ACA meeting wearing C-Legs but sitting in wheel chairs, made
me puke.

Mark ups of 100-150 % profit for providers to the cost of these hi-tech
computer aided components can put $20k to $40 k in the pockets of some
unscrupulous practitioners abusing the system.

When was the last time you saw a Drs.perscription say fit for C-Leg or
Rhino knee?
Most of them cant spell prosthesis !

One national O&P chain increased their profits dramatically last quarter by
having a routine patient evaluation clinics where folow up visits are
scheduled 3-6 months after the initial fitting to determine if the patient
(and the benefits) would cover upgrading to higher priced components.

Even the tremendous mark up of silicon liners ,high tec feet and other
supplies and components for reimbursement is out of control and profit
margins for providers continues to be like green carrots dangling from a
string for some providers to take advantage of.All of which ubfortunately
are classified as DME by most insurers.

Where is the accountability of it all?

As my friend Johnny Morgan said, There are no degrees of integrity and
ethics .Either you have it or you do not.

There is good and bad in every profession, the problem with this O&P world
is you cant get the bad ones (providers)out and in 39 states there is no
minumum standard of qualifications.!

Anthony T. Barr
President
Barr Foundation
www.oandp.com/barr
www.ErtlReconstruction.com


-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Shandon Hime, CP
Sent: Thursday, October 05, 2006 7:00 AM
To: <Email Address Redacted>
Subject: [OANDP-L] FW: [OANDP-L] Local prosthetist medicare rip off?

-----Original Message-----
From: Shandon Hime, CP [mailto:<Email Address Redacted>]
Sent: Thursday, October 05, 2006 9:56 AM
To: <Email Address Redacted>
Subject: RE: [OANDP-L] Local prosthetist medicare rip off?

In regards to the 51 Y/O TF patient that was fit with the microprocessor
control knee joint. From your post he is a low functional level K3 patient
and is capable of independent ambulation. From your limited patient
information this is a good candidate for this technology. It would be more
constructive to replace the ill fitting socket than to give the impression
that our profession routinely rips off insurance companies. This way you
prove that our profession provides the necessary integrity and skills to
produce a successful patient out come. If this other company is your
competitor, you prove that you can provide much better patient care. Do
this enough times and they will not be a competitor any more, or they will
improve there clinical skills and compete with you. In the end, the
amputees that need our professions help in your area will be better severed
though better patient care.

-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Phillipe Cartaya CPO
Sent: Wednesday, October 04, 2006 8:30 PM
To: <Email Address Redacted>
Subject: [OANDP-L] Local prosthetist medicare rip off?

 Thought I would share this with you Unfortunately we have all seen it but i
Was even taken aback by this. A 51 yr old A/K was sent to me with a
prostheses made for him by another company he limped in wearing a Rheo
computer knee on top of a ceterus foot. probably the most expensive system
that could have been put on him.He was a high K2 high k3 . he certainly
didn't come close to doing any activity that would warrant this system Of
course with the cheapest socket, just laminated. This poor guy wasn't even
close to being a candidate for this.You would think with the extra money the
prosthetist made he would have at least sprung for a flex inner socket so
the guy MIGHT have been comfortable. The prox socket had been cutting into
him since January when he received it hehas een stuffing socks into the
prox brim. He was a very long A/K so he had a locking mech under the socket
with the length of the ceterus foot and rheo knee, imagine how low the knee
center was. He was told th!
 at if the surgeon had only cut of another couple of inches he ( the
prosthetist ) could have done a better job as far as height. If he had used
appropriate complementary he would have had plenty of room. At least i said
if he was able to walk well with the leg one could say the his provider
might have made a ton of money but at least he would be able to get around.
Of course if the prosthetist was questioned he would say the doctor signed
of on it . we al know we can send almost any request to most MDs as they
dont know what the items mean. Mabey im not thinking ahead of the curve ,
again the leg weighed 11 pounds .does anyone else consider this a rape of
the system? Phillipe Cartaya CPO, myrtle beach SC
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