Thompson, Berkley Introduce Medicare Orthotics and Prosthetics Improvement Act of 2011

May 24, 2011 Issues: Healthcare

Washington, D.C. – Representatives Glenn ‘GT’ Thompson (R-PA) and Shelley Berkley (D-NV) today introduced H.R. 1958, the Medicare Orthotics and Prosthetics Improvement Act of 2011, legislation to improve the quality of orthotic and prosthetic (O&P) care and reduce fraudulent payments for orthotic and prosthetic services under Medicare.   

“Fraud and abuse contributes not only to rising costs, but it also harms patients, particularly when medically necessary devices are provided without expert care or without necessity,” said Thompson. “We need to collectively look to create savings by combating waste, fraud, and abuse. This legislation will enhance patient care and ensure that Medicare fraud is addressed, particularly when the fiscal solvency of the program is in question.”

In the Benefits Improvement and Protection Act of 2000 (BIPA), Congress mandated that a practitioner or supplier had to be certified in order to be paid for certain orthotic and prosthetic services under Medicare.  This was never implemented, contributing to fraudulent payments and leaving Medicare patients vulnerable to substandard care.  H.R. 1958 would require the Centers for Medicare and Medicaid Services (CMS) to reimburse only those providers who have been accredited or licensed in orthotics and prosthetics. 

“Our legislation seeks to improve care for patients with orthotics and prosthetic devices and to ensure they are receiving treatment from those who are best suited to address their particular medical needs. At the same time, our bill will save money by cracking down and ending fraudulent payments through Medicare,” said Berkley.  

Additional information on the Medicare Orthotics and Prosthetics Improvement Act:

CMS has not followed through on certification requirements.  Under BIPA, O&P practitioners or suppliers must be accredited or certified in order to be reimbursed through Medicare. This was never implemented. Ten years later, Medicare beneficiaries do not yet enjoy these protections. H.R. 1958 will enforce these protections.

Unlicensed suppliers are still receiving Medicare payments.  In 2005, Medicare instructed contractors to pay suppliers of orthotic and prosthetic services in states requiring licensure only if they were in fact licensed.  However, CMS contractors did not put in place the steps necessary to implement this requirement.  H.R. 1958 would require CMS to report to Congress on its enforcement efforts to reduce fraud and abuse.

A provision in recent Medicare legislation exempted providers from certification requirements.  In the recently passed Medicare Improvements for Patients and Provider Act (MIPPA), almost all providers and suppliers were exempt from accreditation and quality standards until the Secretary determines standards apply to them. This leaves patients vulnerable to substandard care and a reimbursement system subject to fraud and abuse. H.R. 1958 will prevent these practices, reducing unnecessary beneficiary co-pays and federal outlays to unqualified entities.

Representative Thompson, a former therapist and licensed nursing home administrator with 28 years of experience in a non-profit health setting, currently serves on the House Education & the Workforce Committee.  Serving Nevada in Congress since 1999, Representative Berkley is a Member of the House Committee on Ways and Means and a strong advocate for America’s veterans.

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