Fwd: Total Body Orthotic System
Wil Haines
Description
Collection
Title:
Fwd: Total Body Orthotic System
Creator:
Wil Haines
Date:
11/8/2010
Text:
-------- Original Message --------
Subject: Total Body Orthotic System
Date: Mon, 08 Nov 2010 11:58:52 -0500
From: Wil Haines < <Email Address Redacted> >
To: <Email Address Redacted>
Hello colleagues and guests,
I still have a copy of the 1994 Department of Health and Human
Services report from the Office of Inspector General which is titled
Medicare Payments For Orthotic Body Jackets. In that report, the OIG
department noted that 95% of orthotic body jacket claims paid by
Medicare were for non-legitimate devices. Here is the language from the
next paragraph. Ninety-five percent of our sampled claims (90 of 95)
submitted under code L0430, were for devices which were not orthotic
body jackets. Hereafter, we will refer to these as non-legitimate
devices. The remaining 5 percent (5 of 95) were for legitimate body
jackets. We noticed that the legitimate body jackets in our sample were
supplied by certified, licensed orthotist whose primary occupation is
supplying orthotic and prosthetic devices to patients. The
non-legitimate body jackets in our sample were supplied by Durable
Medical Equipment (DME) suppliers that primarily supply DME equipment
and supplies, not orthotics.
I'm also including a follow-up 1999 article by the OIG's office that
some might find interesting. This article shows progress for reducing
fraud for body jacket billings, but it also points out HCFA's refusal to
work with AOPA.
Here is the link to the 1999 OIG article:
<URL Redacted>
Attached is a link to a congressional website regarding an orthotic
device known as the total body orthotics positioning system, or TBO
6000. Evidently, this system is now in use at nursing homes because of
new changes to wheel chair regulations and is considered an orthotic
device. I don't believe any language in the article approves such a
device as the TBO 6000 as an orthosis, but that is my interpretation,
not fact. I have been told that this device is evidently being billed to
Medicare successfully as an orthosis. I just learned about this from a
therapist who recently had to work with one of these and it evidently
caused the patient a significant pressure ulceration.
As you can see, the federal government still has not reined in fraud and
abuse in the orthotic world and we are and have been heavily paying the
price for it. How we can sit back and not march on Washington in numbers
demanding an explanation for why we are being singled out, due to the
wrongful actions, mostly by others, is beyond me. If L- Codes were
restricted to licensed orthotists and prosthetists, it would be much
easier to track improprieties associated with orthotic and prosthetic
services. So, in my mind, the federal government is largely responsible
for the O&P fraud and abuse that has been allowed to accrue, based upon
their unwillingness to separate O&P from DME.
Here is the ling to the congressional article:
<URL Redacted>
I'm also attaching a photograph of the TBO 6000 orthotic device.
The link for the picture is:
<URL Redacted>
Here is the real rub. Because DME is not reimbursable in a nursing home,
but orthotic devices are, in some cases, some folks and manufacturers
are jumping through hoops to get their devices accepted by Medicare as
an L-Code orthotic device. We have known all along that it was wrong to
consolidate DME and O&P into the same arena, but here is further proof
that problems exist because of it. How any government official can look
at a wheelchair or any other kind of chair and believe it is an orthotic
device is beyond my imagination. I have no problem with such a device
being billed as a postural seating device, using appropriate E-Codes,
but I do have a problem with this being billed using L-Codes.
Are there any comments?
Wil Haines, CPO
MaxCare Bionics
Avon, IN
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If you have a problem unsubscribing,or have other
questions, send e-mail to the moderator
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OANDP-L is a forum for the discussion of topics
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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.
Subject: Total Body Orthotic System
Date: Mon, 08 Nov 2010 11:58:52 -0500
From: Wil Haines < <Email Address Redacted> >
To: <Email Address Redacted>
Hello colleagues and guests,
I still have a copy of the 1994 Department of Health and Human
Services report from the Office of Inspector General which is titled
Medicare Payments For Orthotic Body Jackets. In that report, the OIG
department noted that 95% of orthotic body jacket claims paid by
Medicare were for non-legitimate devices. Here is the language from the
next paragraph. Ninety-five percent of our sampled claims (90 of 95)
submitted under code L0430, were for devices which were not orthotic
body jackets. Hereafter, we will refer to these as non-legitimate
devices. The remaining 5 percent (5 of 95) were for legitimate body
jackets. We noticed that the legitimate body jackets in our sample were
supplied by certified, licensed orthotist whose primary occupation is
supplying orthotic and prosthetic devices to patients. The
non-legitimate body jackets in our sample were supplied by Durable
Medical Equipment (DME) suppliers that primarily supply DME equipment
and supplies, not orthotics.
I'm also including a follow-up 1999 article by the OIG's office that
some might find interesting. This article shows progress for reducing
fraud for body jacket billings, but it also points out HCFA's refusal to
work with AOPA.
Here is the link to the 1999 OIG article:
<URL Redacted>
Attached is a link to a congressional website regarding an orthotic
device known as the total body orthotics positioning system, or TBO
6000. Evidently, this system is now in use at nursing homes because of
new changes to wheel chair regulations and is considered an orthotic
device. I don't believe any language in the article approves such a
device as the TBO 6000 as an orthosis, but that is my interpretation,
not fact. I have been told that this device is evidently being billed to
Medicare successfully as an orthosis. I just learned about this from a
therapist who recently had to work with one of these and it evidently
caused the patient a significant pressure ulceration.
As you can see, the federal government still has not reined in fraud and
abuse in the orthotic world and we are and have been heavily paying the
price for it. How we can sit back and not march on Washington in numbers
demanding an explanation for why we are being singled out, due to the
wrongful actions, mostly by others, is beyond me. If L- Codes were
restricted to licensed orthotists and prosthetists, it would be much
easier to track improprieties associated with orthotic and prosthetic
services. So, in my mind, the federal government is largely responsible
for the O&P fraud and abuse that has been allowed to accrue, based upon
their unwillingness to separate O&P from DME.
Here is the ling to the congressional article:
<URL Redacted>
I'm also attaching a photograph of the TBO 6000 orthotic device.
The link for the picture is:
<URL Redacted>
Here is the real rub. Because DME is not reimbursable in a nursing home,
but orthotic devices are, in some cases, some folks and manufacturers
are jumping through hoops to get their devices accepted by Medicare as
an L-Code orthotic device. We have known all along that it was wrong to
consolidate DME and O&P into the same arena, but here is further proof
that problems exist because of it. How any government official can look
at a wheelchair or any other kind of chair and believe it is an orthotic
device is beyond my imagination. I have no problem with such a device
being billed as a postural seating device, using appropriate E-Codes,
but I do have a problem with this being billed using L-Codes.
Are there any comments?
Wil Haines, CPO
MaxCare Bionics
Avon, IN
********************
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
Wil Haines, “Fwd: Total Body Orthotic System,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/232004.
