AOPA Continues Dialogue with OIG Regarding L0631 Spinal Orthoses


In an April 19, 2013 letter to Inspector General Daniel Levinson and Deputy Inspector General for Evaluation Stuart Wright, AOPA addressed several concerns regarding assertions that were made in the OIG response to AOPA’s comments on the December 2012 OIG report entitled Medicare Supplier Acquisition Costs for L0631 Back Orthoses.

AOPA provided initial comments on the report in a January 8, 2013 letter and received a response on April 3, 2013.  The April 19th letter was sent in order to express AOPA’s concern regarding several statements that were made by the OIG in its initial response.  Of specific concern to AOPA was a statement in the OIG response that, “there are no requirements regarding the type of supplier that may provide an L0631; beneficiaries can obtain one from any enrolled Medicare supplier provided that they have a written order from a physician.”  The OIG implies that this statement justifies the inclusion of L0631 in future rounds of competitive bidding as a means to reduce Medicare reimbursement.  AOPA does not agree that L0631 should be classified as an off the shelf orthosis subject to inclusion in competitive bidding and that it requires the clinical knowledge and experience of a properly trained healthcare professional, such as an orthotist, to ensure a quality clinical outcome for the patient.

AOPA also expressed its concern that both the original report and the April 3rd OIG response conveyed an apparent lack of familiarity with qualified provider language provision of section 427 of the BIPA Act as well as the OIG’s own report on CMS’ failure to promulgate regulations in order to Implement them.  AOPA strongly reiterated its position that proper regulation of existing legislation would provide a better solution than exposing Medicare beneficiaries to substandard care by unqualified providers by including L0631 in future rounds of competitive bidding.

AOPA will continue its dialogue with the OIG in an effort to ensure that Medicare beneficiaries continue to have access to quality healthcare provided by properly trained and qualified professionals.