Medicare Law
Wil
Description
Collection
Title:
Medicare Law
Creator:
Wil
Date:
11/12/2012
Text:
Hello Colleagues and Guests,
There have been questions regarding the possibility of our group merging
with the recent American Hospital Association (AHA) Medicare lawsuit.
The answer is that we will not be able to do that.
With that said, important information is being shared with us regarding
the possibility of us filing our own lawsuit at some point in time.
Hopefully, we will get these issues resolved before that is necessary.
But, just in case it comes to that, we need to research the law and
point out the illegality of Medicare's enforcement of same when we get
to the administrative law judge (ALJ) suit venue. In other words, when
we get to the ALJ, we need to be able to show them where federal law is
being violated. Perhaps, this may be found in several different places,
but I am not suggesting that at this point. We will need legal opinions
about these matters. An example, however, may be that Small Business
Administration, Ombudsman legislation (statutes) are being violated by
the sheer financial impact of the Medicare auditors on our practices.
What, for example, defines random audits and at what point in a revenue
stream does an audit become excessive and unreasonable for the small
business involved? I feel certain there are other areas within the
federal statutes that will surface as we investigate Medicare law. We
have been told that unless we can show where the statutes are being
violated, and present this information to the ALJ, we will have little
chance of making progress in these matters when we get to that point.
That does not mean that ALJ decisions will not be overturned in our
favor without such information, but it will add to the credibility of a
potential law suit holding those responsible for our burdens
accountable. When RAC auditors make incorrect decisions, should they not
be held financially accountable for their actions?
We still believe that the best long term solution will be that the
professional orthotist and prosthetist be given the authority to write,
in consultation with the prescribing physician, the definitive Medicare
prescription. This will not downgrade the physicians important role in
the process in any way. If anything, it will enhance the communication
between the prescribing physician, the professional orthotist and
prosthetist, Medicare and last, but not least, the patient. It will also
open opportunities for better communication between the O&P practitioner
and physical and occupational therapists. How could this not be a
win-win situation?
As we move toward that goal, several important pieces of the puzzle must
be obtained and successfully presented to the appropriate people. If,
and I repeat, if we are successful along the way, we believe we will
have a good chance of effecting appropriate change within the Medicare
system. As most of you know, what happens with Medicare eventually
trickles downstream to other insuring agencies. We are moving toward
that goal, albeit slowly at this point, but nevertheless we are moving.
If I have sounded negative at times during this process, it is simply
because I (we) are fed up with the inattentive bureaucracy and largely
BS that seems to prevail within our government from both sides of the
isle. If that message does not ring loud and clear as you read the AHA
federal lawsuit against the Secretary of Health and Human Resources,
then I suppose we are in big trouble. But beyond the federal statute
violation issues, there are other administrative decisions that come
from Medicare that are simply wrong. Medicare is telling us that we are
responsible for educating the physicians and ensuring that they comply
with Medicare O&P regulations. Without a valid explanation, that is one
of the most stupid federal policies that I have ever heard and it
certainly helps make the case for who should be writing the definitive
Medicare prescriptions.
At the end of the day, our hope is that we will be able to join forces
with several of our state and national associations, other professional
groups, and patient groups to make a united stand to help get these
problems solved. Will that happen? Time will tell.
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
There have been questions regarding the possibility of our group merging
with the recent American Hospital Association (AHA) Medicare lawsuit.
The answer is that we will not be able to do that.
With that said, important information is being shared with us regarding
the possibility of us filing our own lawsuit at some point in time.
Hopefully, we will get these issues resolved before that is necessary.
But, just in case it comes to that, we need to research the law and
point out the illegality of Medicare's enforcement of same when we get
to the administrative law judge (ALJ) suit venue. In other words, when
we get to the ALJ, we need to be able to show them where federal law is
being violated. Perhaps, this may be found in several different places,
but I am not suggesting that at this point. We will need legal opinions
about these matters. An example, however, may be that Small Business
Administration, Ombudsman legislation (statutes) are being violated by
the sheer financial impact of the Medicare auditors on our practices.
What, for example, defines random audits and at what point in a revenue
stream does an audit become excessive and unreasonable for the small
business involved? I feel certain there are other areas within the
federal statutes that will surface as we investigate Medicare law. We
have been told that unless we can show where the statutes are being
violated, and present this information to the ALJ, we will have little
chance of making progress in these matters when we get to that point.
That does not mean that ALJ decisions will not be overturned in our
favor without such information, but it will add to the credibility of a
potential law suit holding those responsible for our burdens
accountable. When RAC auditors make incorrect decisions, should they not
be held financially accountable for their actions?
We still believe that the best long term solution will be that the
professional orthotist and prosthetist be given the authority to write,
in consultation with the prescribing physician, the definitive Medicare
prescription. This will not downgrade the physicians important role in
the process in any way. If anything, it will enhance the communication
between the prescribing physician, the professional orthotist and
prosthetist, Medicare and last, but not least, the patient. It will also
open opportunities for better communication between the O&P practitioner
and physical and occupational therapists. How could this not be a
win-win situation?
As we move toward that goal, several important pieces of the puzzle must
be obtained and successfully presented to the appropriate people. If,
and I repeat, if we are successful along the way, we believe we will
have a good chance of effecting appropriate change within the Medicare
system. As most of you know, what happens with Medicare eventually
trickles downstream to other insuring agencies. We are moving toward
that goal, albeit slowly at this point, but nevertheless we are moving.
If I have sounded negative at times during this process, it is simply
because I (we) are fed up with the inattentive bureaucracy and largely
BS that seems to prevail within our government from both sides of the
isle. If that message does not ring loud and clear as you read the AHA
federal lawsuit against the Secretary of Health and Human Resources,
then I suppose we are in big trouble. But beyond the federal statute
violation issues, there are other administrative decisions that come
from Medicare that are simply wrong. Medicare is telling us that we are
responsible for educating the physicians and ensuring that they comply
with Medicare O&P regulations. Without a valid explanation, that is one
of the most stupid federal policies that I have ever heard and it
certainly helps make the case for who should be writing the definitive
Medicare prescriptions.
At the end of the day, our hope is that we will be able to join forces
with several of our state and national associations, other professional
groups, and patient groups to make a united stand to help get these
problems solved. Will that happen? Time will tell.
Wil Haines, CPO
MaxCare Bionics
Avon, IN 46123
Citation
Wil, “Medicare Law,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/234148.
