The United States District Court of the District of Columbia recently dismissed a case brought by the American Orthotic and Prosthetic Association (AOPA) against Former Secretary of the Department of Health and Human Services Kathleen Sebellius. The suit focused on the authority of Medicare and contracted auditors to reinterpret and retroactively apply regulations pertaining to documentation requirements for billing orthotics and prosthetics. A copy of the ruling can be found here.
AOPA argued that CMS rules provide that suppliers of prosthetic devices will be denied payment for the devices unless they secure specific documentation from physicians who prescribed the devices.
“CMS and its contractors are relying on the new rules to deny AOPA members payment for the prosthetic devices the AOPA members have supplied Medicare patients, even when other documentation justifies the medical necessity for the devices.”
One of the major claims AOPA made in the suit is that the CMS audit contractors have inappropriately applied the new standard articulated in the August 2011 Dear Physician Letter retroactively to claims in 2009 or 2010, “well before anyone had any reason to think the standard had changed”.
In an order granting the agency’s motion to dismiss, U.S. District Judge Royce C. Lamberth said AOPA’s claims were not redressable by judicial action, because the agency was exercising discretion it already possessed, and AOPA therefore lacked standing.