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Medicare Audits

 ·       I have been a provider since 2001.

 ·       I am a Licensed Orthotist and also am ATP Certified in mobility devices.

 ·       We are licensed by the State, for DME and Orthotics.

 ·       We are accredited by the State and Federal Government.

 ·       Medicare requires a Surety Bond in case of fraud from each supplier for $50,000


We have state associations for DME as well as Orthotics and Prosthetics.

Every provider has a unique supplier number that tells exactly what claims and products are received through our supplier numbers. In spite of all of these measures on a local and national level, suppliers are still treated as if we are not trustworthy.

We are not paid for our education at all. We are only reimbursed for a product that we provide. As an Orthotist that pays for CEUs each year as well as my overall education and years in experience, I am paid the same fee schedule as any other person with a supplier number without my education or licenses.

In the light of all of the fraud and abuse in our industry, Medicare is allowing and condoning more and more mail order companies to provide products to their beneficiaries. I am sorry but this simply does not work in bracing! They have the patient measuring them self and fitting themselves! These suppliers from out of state are billing Medicare for a claim description that says that they fit and adjusted the brace to the patient. How can this be when they are in a different state? Then Medicare wonders how there is fraud?

Due to allowing these “suppliers” to mass market and sell direct to the end user, it has resulted in an over utilization. This in turn sparks an audit of that code group against ALL providers. These marketing companies do not have any loyalty to the physician or their staff but rather to getting the product billed. So this leads to them harassing the physician’s office and over burdening their fax machines! Medicare and the OIG finally investigated and tried to close the mobility company that was doing this, but now they are allowing the same approach to braces! Did they not learn at all?

The audits in the past have included requesting documentation and making sure that the medical need was justified and that the item billed for was the item that was provided. Today’s audits take on an entirely new agenda. CMS and Medicare have allowed the contracting of auditors, which are attorney offices, and they are not looking for medical justification or if the proper product was delivered, they are looking for technicalities of certain dates and if date stamps were used or not. These “auditors” are only paid a commission of what they “find.” Their system is guilty until proven innocent! They are no longer considering the patient’s medical condition or their need for the equipment that was ordered and provided.

The RAC Auditors were introduced to our industry as fraud preventers. They were hired to find those providers that were billing for items that were never delivered. The OIG report lays out real objective issues that should be enforced and monitored. CMS however has added hundreds of requirements that make it nearly impossible to remember them all much less try to get a physician to meet the requirements that they have never seen or read. 

The RAC Auditors were given authority over all Medicare claims, for Part A and Part B claims. They first wrote a program to compare inpatient and outpatient claims. This is a real issue and was justified. This provided them with revenue and reason to investigate as they uncovered many inappropriate claims. Many of these claims were provided by the prompting of hospitals or rehab centers over patient needs but the provider did not know that the facility had to cover those services since the patient was in patient at the time of fitting.

Their requirements forced my company of mobility. They have forced many providers out of business altogether.  The requirements ruin the supplier-physician relationship. When we have to interrupt their clinic over and over again to have them write and rewrite their chart notes, or orders they simply quit ordering the equipment! The entire reason that I love the industry that I am in is because our products do not have negative side effects! We help people get their lives back through services that do not require them to miss work or worry about long term side effects such as liver damage or kidney damage as experienced with long term use of medications.

The other problem is that there is no end in sight! You never reach a “good standing” with these auditors! They can go back three years and they send ten new audits every thirty days. This process weighs the company down to a point that they can no longer go on. This leads to shortages and delays in care for the patient.

We need your help, the voice of the beneficiary carries more weight than a thousand providers screaming. PLEASE CONTACT MEDICARE ABOUT THE AUDITS. Also contact your congressman or senator for their help in preventing the delays in service that will result if these audits are allowed to continue!

 Medicare Patients Can Call 1-800-MEDICARE (1-800-833-2219)

Residents of Alabama are represented in Congress by 2 Senators and 7 Representatives.
Member Name DC Phone DC FAX Contact Form
Senator Richard Shelby (R- AL) 202-224-5744 202-224-3416 http://www.shelby.senate.gov/public/index.cfm/emailse …
Senator Jeff Sessions (R- AL) 202-224-4124 202-224-3149 http://www.sessions.senate.gov/public/index.cfm?FuseA …
Representative Jo Bonner (R - 01) 202-225-4931 202-225-0562 https://forms.house.gov/bonner/webforms/issue_subscri …
Representative Martha Roby (R - 02) 202-225-2901 202-225-8913 https://roby.house.gov/contact-me
Representative Mike Rogers (R - 03) 202-225-3261 202-226-8485 https://mike-rogers.house.gov/contact-mike/email-me
Representative Robert B. Aderholt (R - 04) 202-225-4876 202-225-5587 http://aderholt.house.gov/email-me2/
Representative Mo Brooks (R - 05) 202-225-4801 202-225-4392 https://brooks.house.gov/email-me
Representative Spencer Bachus (R - 06) 202-225-4921 202-225-2082 https://writerep.house.gov/writerep/welcome.shtml
Representative Terri A. Sewell (D - 07) 202-225-2665 202-226-9567 https://sewell.house.gov/contact-me/email-me