AOPA Unequivocally Renews its Support of Efforts to Combat Fraud and Abuse through Improper Orthotic and Prosthetic Care
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ALEXANDRIA, Va., April 29, 2021 /PRNewswire/ The American Orthotic and Prosthetic Association (AOPA), founded in 1917, represents more than 2,000 patient care facilities and businesses that manufacture, distribute, design, fabricate, fit, and supervise the use of orthoses (orthopedic braces) and prostheses (artificial limbs).
In April 2019, following an extensive investigation dubbed Operation Brace Yourself, the Department of Justice (DOJ) announced a series of criminal indictments that identified more than $1.2 billion in losses to the Medicare program through the fraudulent provision of orthoses. The fraudulent activity relied heavily on the use of lead generation and advertising strategies to arrange the shipment of one or more orthoses to Medicare beneficiaries without providing any evaluation or
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On April 27, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the 2022 Inpatient Prospective Payment System (IPPS) Proposed Rule for Acute Care Hospitals. The IPPS Proposed Rule contains a number of proposals related to hospitals and the Medicare program some payment-related and others policy-related. Several of the proposals are highlighted below.
Price transparency
While CMS has not thrown out the entire price transparency rule, it is proposing to repeal the requirement it finalized last year that hospitals report the payer-specific rates for inpatient services they negotiate with Medicare Advantage plans on their cost reports. CMS estimates that repealing just this part of the price transparency requirement will reduce administrative burden on hospitals by approximately 64,000 hours.
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Some smaller rural hospitals, such as Miller County Hospital in Colquitt and Jenkins County Medical Center in Millen, are complying as well as larger ones in the state.
Even when posted, the information is not always easy to find, judging from a recent search through several hospital websites. A consumer often has to search under tabs such as PATIENTS and look for a pricing button.
And some hospitals have set up requirements that a consumer give personal information before getting a price estimate. Such info barriers arenât allowed under the rule, Dorstel says.
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Fisher is the founder and chairman of patientrightsadvocate.org – a non-profit pushing for transparency in healthcare pricing.
“Can you imagine standing at a grocery store and paying 10 times more for a gallon of milk and a bunch of bananas than the person in front of you? We wouldn’t tolerate it,” Fisher said.
This rule change was part of theAffordable Care Act and it was just implemented this year.
According to the Centers for Medicare and Medicaid Services (CMS), hospitals are now “…required to provide clear, accessible pricing information online about the items and services they provide.”
CMS says the information should include discounted cash prices and payer-specific negotiated rates.