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DIABETIC SHOE BILL SCAM?

Posted by BGCPed on 11/11/02 at 20:17 (099838)

I was wondering if Richard or someone else that deals with this bill. I had a pt in today that was an elderly diabetic. A company that adverises to take care of your diabetic supplies with no hassle had a person come out and fit her in an off the shelf depth shoe that retails for about $100 and a off the shelf insert that was sorbathane with a plastizote top, about $20 retail.

When her daughter got the bill that medicare paid it was for $240. I realize there is a combination of inserts/shoes they can receive but at that cost and none of it was custom or molded just off shelf I was wondering if that price is overcharge. I thought a code of A 5500 is for off shelf shoe and that pays about $110 a pair or so I was told by a biller for an O&P near me

Re: DIABETIC SHOE BILL SCAM?

Dr. Zuckerman on 11/12/02 at 07:54 (099860)

There is a medicare bill for Diabetic shoe. I do know that don't have to be custom. The typical cost to the dispensing doctor is about $100-$120. There is specific criteria for patients to meet the payment guildlines. They are very specifice. Just the diagnosis of Diabetes does pass the coverage guildlines

Re: DIABETIC SHOE BILL SCAM?

Richard, C.Ped on 11/12/02 at 08:14 (099862)

Hey Brian,
This is what I understand about the Diabetic Shoe Bill. The A5500 will allow up to $126 for one pair of shoes. The new code for the inserts is A5511. This code allows $198 for three pairs of inserts (what a joke). The tricky part comes when someone such as these jerks will bill for A5511 which is defined as a custom molded product ONLY. The A5509 and A5510 is a direct molded device. I have used the 09 and 10 before in coding, and it came back rejected as a non covered device.

What this means is if someone uses the A5511 code on a generic off the shelf diabetic insert, that is Medicare fraud. That is for custom molded orthotics only.

I get VERY frustrated with companies such as this when they advertise that they accept Medicare. Most of the time they will take Medicare, but do not 'Accept Medicare Assignment'. If they just 'take' Medicare, they can pretty much bill what they want to. If they accept assignment, they have to take what Medicare allows.

I had a recent repeat patient that forgot my phone number and called Foot Solutions hoping to get my number (as if they would tell her...lol). On the phone, they said they took Medicare. When she went to see them, they were going to sell her a pair of $65 retail P.W. Minor shoes with three pair of off the shelf plastazote inserts for $456. $456!!!!!!!!!!!!!!!
Since they did not accept assignment, they wanted her to pay up front then bill Medicare herself. GRRRRRRRRRRRRRRRRRRRRRRRRRR!!!!!!!!!!!!!!!!!!!

She knew that was not how I did things. I just so happend to send a yearly reminder to her about a day after that. She called me and we took care of her 'our way'.

Back to your question. I do think they need contact the Ombudsman for their region and ask for an investigaton. From what I understand, if you use the A5511 for an off the shelf device, that is considered fraud.

Sorry for the long post. I just feel very passionate about this sort of thing.

Richard, C.Ped

Re: DIABETIC SHOE BILL SCAM?

BGCPed on 11/12/02 at 09:06 (099869)

Me too, thanks I hate this sort of thing as well. Bottom line was all she got was a off shelf depth soe that retails for about $110 and an insert off shelf (1 pair) for $245 I will forward info to her, I think Medicare has a line for fraud so patients can call and forward this info. I also thought there is some kind of 'reward' if they are causght, may help patients become more involved if they get something for it.

BTW the company was I think calledf Liberty Medical?

Re: DIABETIC SHOE BILL SCAM?

Richard, C.Ped on 11/13/02 at 15:55 (100064)

Brian,
I found a phone number that might work. It is for Michigan Region B Durable Medical Equipment. It is Administar Federal Incorporated...1-800-270-2313. They should be able to direct them to the Ombudsman for that area.
Richard

Re: DIABETIC SHOE BILL SCAM?

BGCPed on 11/13/02 at 20:27 (100085)

Thanks I will forward that to the patient

Re: DIABETIC SHOE BILL SCAM?

Dr. Zuckerman on 11/12/02 at 07:54 (099860)

There is a medicare bill for Diabetic shoe. I do know that don't have to be custom. The typical cost to the dispensing doctor is about $100-$120. There is specific criteria for patients to meet the payment guildlines. They are very specifice. Just the diagnosis of Diabetes does pass the coverage guildlines

Re: DIABETIC SHOE BILL SCAM?

Richard, C.Ped on 11/12/02 at 08:14 (099862)

Hey Brian,
This is what I understand about the Diabetic Shoe Bill. The A5500 will allow up to $126 for one pair of shoes. The new code for the inserts is A5511. This code allows $198 for three pairs of inserts (what a joke). The tricky part comes when someone such as these jerks will bill for A5511 which is defined as a custom molded product ONLY. The A5509 and A5510 is a direct molded device. I have used the 09 and 10 before in coding, and it came back rejected as a non covered device.

What this means is if someone uses the A5511 code on a generic off the shelf diabetic insert, that is Medicare fraud. That is for custom molded orthotics only.

I get VERY frustrated with companies such as this when they advertise that they accept Medicare. Most of the time they will take Medicare, but do not 'Accept Medicare Assignment'. If they just 'take' Medicare, they can pretty much bill what they want to. If they accept assignment, they have to take what Medicare allows.

I had a recent repeat patient that forgot my phone number and called Foot Solutions hoping to get my number (as if they would tell her...lol). On the phone, they said they took Medicare. When she went to see them, they were going to sell her a pair of $65 retail P.W. Minor shoes with three pair of off the shelf plastazote inserts for $456. $456!!!!!!!!!!!!!!!
Since they did not accept assignment, they wanted her to pay up front then bill Medicare herself. GRRRRRRRRRRRRRRRRRRRRRRRRRR!!!!!!!!!!!!!!!!!!!

She knew that was not how I did things. I just so happend to send a yearly reminder to her about a day after that. She called me and we took care of her 'our way'.

Back to your question. I do think they need contact the Ombudsman for their region and ask for an investigaton. From what I understand, if you use the A5511 for an off the shelf device, that is considered fraud.

Sorry for the long post. I just feel very passionate about this sort of thing.

Richard, C.Ped

Re: DIABETIC SHOE BILL SCAM?

BGCPed on 11/12/02 at 09:06 (099869)

Me too, thanks I hate this sort of thing as well. Bottom line was all she got was a off shelf depth soe that retails for about $110 and an insert off shelf (1 pair) for $245 I will forward info to her, I think Medicare has a line for fraud so patients can call and forward this info. I also thought there is some kind of 'reward' if they are causght, may help patients become more involved if they get something for it.

BTW the company was I think calledf Liberty Medical?

Re: DIABETIC SHOE BILL SCAM?

Richard, C.Ped on 11/13/02 at 15:55 (100064)

Brian,
I found a phone number that might work. It is for Michigan Region B Durable Medical Equipment. It is Administar Federal Incorporated...1-800-270-2313. They should be able to direct them to the Ombudsman for that area.
Richard

Re: DIABETIC SHOE BILL SCAM?

BGCPed on 11/13/02 at 20:27 (100085)

Thanks I will forward that to the patient