Congressmen Introduce Bipartisan Medicare Orthotics & Prosthetics Improvement Act

May 25, 2017

Bill would shield Medicare patients from fraud and abuse

WASHINGTON – U.S. Representatives Glenn ‘GT’ Thompson (R-PA) and Mike Thompson (D-CA) this week introduced H.R. 2599, the Medicare Orthotics and Prosthetics Improvement Act of 2017, legislation that will provide much needed protections for Medicare beneficiaries and other patients receiving prosthetic and orthotic services.

“As a former recreational therapist and licensed nursing home administrator, I understand the challenges that those who have suffered serious injuries are facing,” GT Thompson said. “It is our duty to ensure these individuals are not being subjected to further hardships and financial burdens as a result of fraud in the O&P sector. The Medicare Orthotics and Prosthetics Improvement Act of 2017 will strengthen the quality of care while reducing costs within the Medicare program—I am proud to introduce this important bipartisan measure.”

“Medicare beneficiaries in need of prosthetic and orthotic services deserve to know they’re getting the very best care,” Mike Thompson said. Keeping fraudulent providers out of Medicare will ensure patients get the treatment they deserve, and has the added benefit of reducing costs.”

The Benefits Improvement and Protection Act (BIPA), which was signed into law in 2000, mandated that a “practitioner” or “supplier” had to be certified in order to be paid for certain orthotic and prosthetic services under Medicare.

However, the Center for Medicare and Medicaid Services (CMS) has not enforced these provisions since their enactment. This has led to an uptick of fraudulent payment to unlicensed providers, leaving Medicare patients vulnerable to substandard, and in some cases nonexistent, care.

The Medicare Orthotics and Prosthetics Improvement Act of 2017 would:

  • Require CMS to reimburse only those providers who have been accredited or licensed in orthotics and prosthetics;
  • Links the eligibility for payment to the qualification of the providers and the complexity of the device to patient needs for the purpose of targeted care;
  • Establishes orthotists and prosthetists as Medicare providers, distinguishing them from suppliers of Durable Medical Equipment (DME);
  • Clarifies that notes taken by orthotists and prosthetists regarding a particular patient should be considered a legitimate component of the patient’s medical record.