Medicare Information

Medicare Information

Wil

5/31/2013

Hello Colleagues and Guests,

I sent a rather passionate email to Senator Coats a couple days ago and
thought, in retrospect, the timing was good. Hopefully, Senator Coats
will look into this matter in more detail. They are good folks and now
that AOPA has filed the lawsuit and Congress is asking for an SBA
inquiry, maybe, just maybe they will take a closer look. I normally
would not post a personal letter to a Senator, but I thought it was
appropriate, given the timing of what may now be going on with the SBA.

The test is as follows:

Dear Honorable Senator Coats:

First, thank you for your recent letter and support regarding gun
legislation.

I, my daughter, and a colleague paid a visit to your D.C. office last
September and outlined the injurious and unlawful Medicare audits that
were being conducted in the orthotic and prosthetic (O&P) profession. We
met with Mr. Samuel Blevins who was very cordial and seemed interested
in our cause. But several weeks later, in follow-up, I was told there
was little that could be done, primarily because there were no
complaints about this issue. I guess our complaint was not important
enough to investigate further. Frankly, Senator Coats, Medicare is and
has been on a witch hunt in our profession and the problems continue to
this day. As a result, it is now estimated that as many as 30-40% of the
small businesses that provide orthotic and prosthetic services will go
bankrupt and the lives of those business owners will never be the same
again. The lives of many of their patients may never be the same either
since procuring valid payment for Medicare (O&P) services, as prescribed
by federal law, is nearly impossible today. Furthermore, their opinions
and respect for government will likely never be the same again either. I
know that my respect for government, particularly for those inside the
beltway, is now gone. I can also tell you that I will now be focused on
doing whatever I can to help eliminate big government and the greed and
corruption that has penetrated deep into the bowels of our United States
of America.

I and many of my colleagues are virtually in tears about what is
happening to the orthotic and prosthetic profession. This is my 46^th
year in the business and while I am in the sunset years of my
professional career, I am no less concerned about the government
corruption that goes on day after day after day and is affecting the
lives of so many people in the disabled world. On May 13, 2013, the
American Orthotic and Prosthetic Association (AOPA) filed suit in
federal court regarding the willful negligence by Kathleen Sebelius,
Secretary of the Department of Health and Human Services against
orthotic and prosthetic practitioners. I am providing you with a link to
this lawsuit and it can be found on the US Court Electronic Filing
System as 1:13-cd-00697-JDB. If you will take the time to read it, you
will see that CMS has failed to abide by the rules and regulations set
forth by Congress. Before this is all said and done, I believe many
additional lawsuits may be forthcoming by small independent orthotic and
prosthetic business owners, provided they have the skill or resources to
carry one out.

Several months ago, I wrote to Secretary Sebelius warning her of the
coming firestorm in the world of amputees and those with other disabling
conditions. My letter invoked a call from her office as I was traveling
to yours, but there was never any additional follow-up regarding this
matter. I paid a visit to Congressman Todd Rokita's office in Danville,
Indiana prior to coming to your office. The outcome of that encounter
was similar to yours. Their office could not find a problem either. I
also wrote to the SBA and complained about the injurious regulations
that were affecting small orthotic and prosthetic businesses. Once
again, my eyes were opened. I was told the SBA does not meet with people
in a face-to-face manner. Years ago, I had the pleasure of meeting and
working with a very helpful SCORE representative from the SBA.
Evidently, things change. At the end of the day, with exception of a
very polite lady who works for the SBA, the buck was passed and all
responses came from a seemingly corrupt CMS system in a typical
boilerplate manner.

Senator Coats, if you will travel with me to the homes of a few of the
patients whom CMS has declared ineligible for the O&P services that were
provided, I will show you firsthand a tragedy that is unfolding. Then,
perhaps, someone in your office can query CMS to find out why patients
and Medicare providers are being treated in the manner that we are. They
will likely tell you it is because of fraud and abuse within the CMS
system and also due to information that was published by the OIG
regarding the over-usage of care in orthotics and prosthetics. Plain and
simple, that is BS. First, had they enacted the federal legislation that
the AOPA lawsuit references, much of the fraud and abuse they allude to
would never have occurred. This is because Kathleen Sebelius was able to
pick and choose who is eligible to provide O&P care and who was not. In
short, many of those selected by her for the approved list could not
spell orthotics and prosthetics, let alone provide the care. Second, the
OIG report is very misleading and often quite erroneous. Now, CMS is
trying to rein in the fraud and abuse in typical big government fashion
and they are destroying the lives and businesses of many honorable
patients and practitioners in the process. Just yesterday, I was on a
CMS open door forum call regarding the documentation that is being
suggested and required in support of providing a prosthesis to a
Medicare amputee. I listened for one hour. During the call, a
physiatrist came online and offered a more simplified approach to making
the determination as to who will and who will not be a candidate for a
prosthesis. His remarks were like day and night from what CMS is
proposing. If the regulations are left up to the physicians associated
with the federal bureaucracy, it will be a failure for the patients who
need prosthetic care and for the physicians who will ultimately refuse
to provide the kind of documentation that CMS is recommending. Once
again, this call reinforced what we already know. The federal government
is trying to control fraud and abuse without a clue about how to go
about it. Eventually, things will get worked out because the citizens of
our country will demand it. But before that happens, I believe the cost
of providing an artificial limb for a citizen will likely skyrocket and
those reliant upon Medicare may be denied this care completely. .

I believe this lawsuit will expose CMS in ways that will not be
complementary to them or to those in Congress who have failed to
follow-up on their own mandates. What good are mandates if the people
who mandate them don't bother to see if they have been enacted? In my
opinion, Congress is as much to blame for part of this tragedy as CMS.
But obviously, those in charge of CMS evidently think mandates from
Congress don't mean much, else they would have acted according to the
legislation that was enacted 11 years ago. Do you agree?

Thank your for your time and consideration in this matter. I hope that
you will get involved with this issue to help salvage an important
medical service that is quickly going away. If the intent is to make the
orthotic and prosthetic profession a Walgreen's, CVS, Walmart operation,
then I suppose CMS is succeeding with their plan, because only the large
well financed corporations in this field will survive. But having worked
in pharmacy in my younger years, I can tell you that fitting an
artificial limb is a whole different ballgame from counting out pills on
an Abbott counting tray.

I trust I may have the courtesy of your reply.

Sincerely,



Wilbur A. (Wil) Haines, CPO

Certified Prosthetist Orthotist

Avon, In

(317) 442-1946