O&P Spotlight: ‘We're Not The Fraud People'
Orthotics & Prosthetics
on July 27, 2023
This article was originally featured in HME News.
Jim Hewlett, a board certified orthotist who can’t quite exit a profession he loves, shares his thoughts on its nagging fraud and abuse problem, the potential of new legislation to improve access and more.
Hewlett, who has tried to retire a few times since selling his practice 18 years ago, contracted as a survey inspector until the COVID-19 pandemic hit and these days, he teaches and works two days a week at Freedom Prosthetics & Orthotics in St. George, Utah. As an artist, he also paints in his free time.
“I couldn't believe how much I missed patient care, but I’m sticking to two days a week and loving it,” said Hewlett. “I don’t work for the money; I work for goose bumps.”
Hewlett spoke with HME News recently about why a good fitting orthotics device matters.
HME News: In your role as a surveyor, did you see evidence of fraud, waste and abuse?
Jim Hewlett: What (these companies) are doing is calling the patient and saying, “Does your back hurt?” Well, show me someone over 65 that doesn't have back pain. Of course, they're going to say yes. Then they call that patient’s doctor and say, “She said her back really bothers her and we have a special right now for Medicare recipients” and boom. How many patients have I called during inspections that said, “Oh yeah, they sent me a back brace and two new knee braces, and it's still in the box by the front door.”
HME: Do you agree with Medicare that off-the-shelf devices can be provided without a fitter?
Hewlett: When I fit an off-the-shelf device, I may try two or three to find the best fit. I'm not going to just say, “Take it home and figure it out,” and that's what you do when you drop ship. There is nobody involved – Medicare says little or no expertise is needed for OTS devices, but that’s not true. We became certified practitioners for a reason. We're not the fraud people. If you're doing your job right and you are trying to give the patient quality of life, you're not committing fraud.
HME: The new O&P legislation, H.R. 4315, has a new provision that would eliminate a five-year timeline for when Medicare beneficiaries can get replacement devices. What impact could that have for patients?
Hewlett: Five years is just kind of arbitrary. As an example, a patient I fitted with a KAFO brace about eight months ago came back yesterday because it didn’t fit anymore because she lost 37 pounds. How did she lose 37 pounds? Because she was ambulating. When I first met her, she could barely walk and now she walked into my office without a cane. Her health is better and isn't that what our end goal is as practitioners? Luckily, her new brace was covered because she had a change of condition - but if she simply had worn it out due to walking too much it would have been out of pocket unless it was more than five years old.
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