Video and Statement from NAAOP on Filing of AOPA Lawsuit Against HHS
NAAOP
Description
Collection
Title:
Video and Statement from NAAOP on Filing of AOPA Lawsuit Against HHS
Creator:
NAAOP
Date:
5/17/2013
Text:
Please view the video link below for our position on the filing of AOPA's
lawsuit against HHS.
NAAOP's Position on AOPA's CMS Lawsuit
( <URL Redacted>)
On Monday, May 13, 2013, the American Orthotic and Prosthetic Association
(AOPA) filed a lawsuit against Department of Health and Human Services
Secretary Sebelius in federal district court. The lawsuit alleges several
violations of law by the Centers for Medicare and Medicaid Services (CMS) in
connection with extensive and onerous auditing activities of CMS
contractors, as well as CMS' failure to implement statutory directives that
directly link the qualifications of an O&P practitioner or supplier with the
ability to be paid by Medicare. CMS has been obligated to implement and
enforce these O&P provisions since 2000 but has, instead, used audits and
other DME-related tactics to address alleged overpayments, waste and abuse.
NAAOP is not a party to this lawsuit, but our Executive Committee and Board
of Directors had knowledge of this impending legal action and support it. We
understand how difficult it is to prevail against the federal government in
the courts, but at the very least, the filing of this lawsuit will impress
upon CMS the seriousness of this matter for the O&P field.
NAAOP, along with AOPA and all members of the O&P Alliance, have for the
past 20 months waged an aggressive campaign on behalf of our members to fix
or improve the problems brought on by the August 2011 OIG Report entitled,
Questionable Billings for Lower Limb Prosthetics as well as a Dear
Physician letter sent by Medicare's contractors to all enrolled Medicare
physicians. But CMS has been largely unresponsive.
CMS's response to the OIG report was to create a new policy standard without
seeking public notice and comment. This new standard specifies that the
prosthetist's records are of no value in supporting the medical necessity of
a patient's O&P treatment/care. Rather, the new policy states that it is the
content of the physician's records alone that determine medical necessity
for purposes of payment of the prosthetist's charges. Not only was this
policy change issued improperly, but the standard itself is in conflict with
long-standing Medicare law.
NAAOP has been advocating, along with the O&P Alliance organizations, that
CMS must rescind this Dear Physician letter and clarify that prosthetists'
clinical notes are part of the patient's medical record for purposes of
determining medical necessity. CMS must finally regulate Section 427 of the
Benefits Improvement and Protection Act of 2000 (BIPA), linking provider
qualifications with Medicare payment for custom O&P care, even though it has
failed to do so for the past 13 years.
Since NAAOP is not a party to this litigation, we will continue to keep a
line of communication open with CMS officials in hopes of assisting to
resolve this devastating situation for O&P providers and the patients we
serve. We will continue to work in concert with AOPA, AAOP, ABC, and BOC
through the O&P Alliance on this issue, as well as a wide variety of public
policy priorities on behalf of the O&P profession.
Thank you for your support and advocacy on behalf of O&P. Please contact us
if you have any questions.
Please visit our website at: www.naaop.org
NAAOP
1501 M Street, NW
7th Floor
Washington, DC 20005-1700
e-mail: <Email Address Redacted>
(800) 622-6740
(202) 624-0064 Phone
(202) 785-1756 Fax
www.naaop.org
lawsuit against HHS.
NAAOP's Position on AOPA's CMS Lawsuit
( <URL Redacted>)
On Monday, May 13, 2013, the American Orthotic and Prosthetic Association
(AOPA) filed a lawsuit against Department of Health and Human Services
Secretary Sebelius in federal district court. The lawsuit alleges several
violations of law by the Centers for Medicare and Medicaid Services (CMS) in
connection with extensive and onerous auditing activities of CMS
contractors, as well as CMS' failure to implement statutory directives that
directly link the qualifications of an O&P practitioner or supplier with the
ability to be paid by Medicare. CMS has been obligated to implement and
enforce these O&P provisions since 2000 but has, instead, used audits and
other DME-related tactics to address alleged overpayments, waste and abuse.
NAAOP is not a party to this lawsuit, but our Executive Committee and Board
of Directors had knowledge of this impending legal action and support it. We
understand how difficult it is to prevail against the federal government in
the courts, but at the very least, the filing of this lawsuit will impress
upon CMS the seriousness of this matter for the O&P field.
NAAOP, along with AOPA and all members of the O&P Alliance, have for the
past 20 months waged an aggressive campaign on behalf of our members to fix
or improve the problems brought on by the August 2011 OIG Report entitled,
Questionable Billings for Lower Limb Prosthetics as well as a Dear
Physician letter sent by Medicare's contractors to all enrolled Medicare
physicians. But CMS has been largely unresponsive.
CMS's response to the OIG report was to create a new policy standard without
seeking public notice and comment. This new standard specifies that the
prosthetist's records are of no value in supporting the medical necessity of
a patient's O&P treatment/care. Rather, the new policy states that it is the
content of the physician's records alone that determine medical necessity
for purposes of payment of the prosthetist's charges. Not only was this
policy change issued improperly, but the standard itself is in conflict with
long-standing Medicare law.
NAAOP has been advocating, along with the O&P Alliance organizations, that
CMS must rescind this Dear Physician letter and clarify that prosthetists'
clinical notes are part of the patient's medical record for purposes of
determining medical necessity. CMS must finally regulate Section 427 of the
Benefits Improvement and Protection Act of 2000 (BIPA), linking provider
qualifications with Medicare payment for custom O&P care, even though it has
failed to do so for the past 13 years.
Since NAAOP is not a party to this litigation, we will continue to keep a
line of communication open with CMS officials in hopes of assisting to
resolve this devastating situation for O&P providers and the patients we
serve. We will continue to work in concert with AOPA, AAOP, ABC, and BOC
through the O&P Alliance on this issue, as well as a wide variety of public
policy priorities on behalf of the O&P profession.
Thank you for your support and advocacy on behalf of O&P. Please contact us
if you have any questions.
Please visit our website at: www.naaop.org
NAAOP
1501 M Street, NW
7th Floor
Washington, DC 20005-1700
e-mail: <Email Address Redacted>
(800) 622-6740
(202) 624-0064 Phone
(202) 785-1756 Fax
www.naaop.org
Citation
NAAOP, “Video and Statement from NAAOP on Filing of AOPA Lawsuit Against HHS,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/235215.
