HHS Inspector General Takes Swipe at L0631


Writing in AARP The Bulletin, Daniel R. Levinson repeats a faulty assertion first made in the Office of Inspector General Report of December 2012 that Medicare paid an average of $919 for L0631 coded back braces that could be bought on the Internet for $191.  The Medicare reimbursement was supposed to include ongoing clinical care (fitting, refining, patient training, etc;) by a certified orthotist or other qualified healthcare professional.  Yet, the OIG report says one-third of the claims record no evidence that fitting or other ongoing care was provided.

Mr. Levinson’s report further recommended that these devices should either only be provided by competitive bidding or Medicare reduce the reimbursement to the $191 Internet pricing.  Neither recommendation makes sense, even if the facts were correct.

After reviewing the OIG Report, AOPA wrote Mr. Levinson January 8, 2013 pointing out competitive bidding was not an option because the statute defines off-the-shelf orthotics as those devices which only require “minimal self adjustment” by the patient.  The L0631 back braces do not qualify and to include them would violate the law.

AOPA also pointed out limiting reimbursements to the “Internet” price would eliminate the clinical care and patient training required to ensure the proper functionality of the device.

If the AARP article is any indication, these and other arguments AOPA made apparently fell on deaf ears or Mr. Levinson and his staff decided either not to read, or not to recognize the facts outlined in AOPA’s letter which was backed up by solid statistics from Medicare’s own database.

Click here for letter and here for data referenced in letter to read the original January AOPA response to the OIG December Report.  A further response is being prepared for the editors of AARP The Bulletin to set the record straight.

HHS OIG Reports have been the trigger for most of the reimbursement woes visited on the O&P field as members will remember the August 2011 OIG Report on lower limb prostheses which in turn resulted in the “Dear Physician” letter on required documentation that has plagued O&P providers.