Last evening U.S. District Court for the District of Columbia Chief Judge Royce Lamberth issued a decision GRANTING the Government's Motion to Dismiss in the case AOPA filed challenging the Medicare program's actions relating to prosthetic claims, the August, 2011 Dear Physician Letter and the exclusion of the prosthetist's notes from having independent value, separate from the physician's notes as documentation in support of claims.

This is a disappointing result, and obviously, not the one that we had hoped for when we filed the lawsuit in May, 2013. As we stated before embarking on this course of action, filing suit against the federal government is always a risky proposition, and Congress has provided many special rules limiting judicial review with respect to challenging decisions made by Medicare, so that odds for success in suing the Medicare program are very slim historically. The Court granted the government's Motion to Dismiss based on the Court's finding that "AOPA has failed to establish that this Court has jurisdiction over its claims."

There were some aspects of AOPA's lawsuit which we felt had to be in place to properly represent the combined interests of the O&P profession. While this path maximized the benefit if the suit were successful, this "big ask" also served to limit somewhat the prospects for success. The objective of our suit was NOT to have one single claim resolved in favor of a specific O&P firm. Rather, we pursued a course that sought, in essence, to overturn all of the claims in which Medicare utilized the criteria in the Dear Physician letter to claw back money or deny payments. AOPA, being a trade association, doesn't itself file Medicare claims. Finally, with the devastating impact of losses to O&P providers from these audits and denials, we sought an immediate intervention to reverse the losses that ultimately have put over 100 O&P facilities out-of-business. The suit was filed in the context of excessively long delays in getting appeals on claims to the ALJ level. While we cited a limited number of specific claims, in the end, the Court's decision appears to have rested on the fact that AOPA did not identify specific claims that had gone through ALL levels of internal Medicare review up to, and including not just a decision at the ALJ level, but also a decision at the next level, i.e., by the Medicare Appeals Council.

Click here to read more details on the District Court's Ruling on the AOPA Website.

Click here to review the 14 page District Court issued opinion dismissing AOPA's claims.

If  you have questions, please contact us at 571/431-0876 or [email protected].