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05/16/2002 Richard Stess, DPM
Can a DPM Prescribe and Dispense Custom Shoes and AFO’s
Query: Can a DPM Prescribe and Dispense Custom Shoes and AFO’s From: Richard Stess, DPM
We would like an opinion regarding podiatrists being both a prescriber and dispenser for custom shoes and AFO's. Is this addressed by the Stark bill II ? Any changes between Stark I and II regarding this subject?
Richard Stess, DPM richard.stess@med.va.gov
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Response From Josh White, DPM, C.Ped
Podiatrists are permitted to dispense items, reimbursed by Medicare, that they have prescribed, so long as it is done in their own office. A good reference for clarification of the rules addressing physician self referral (Stark II) can be found on the link http://www.house.gov/stark/stark2/Stark2info.html .
Included in this is a reference to the term "Referral".
"Definition of "Referral." The final rule revises the definition of "referral" to exclude services personally performed by the referring physician."
Additionally, under the law, diabetic shoes are not considered to be included as orthotics, prosthetics or prosthetic devices and so the Stark II law does not even apply.
For further information, Joanne Sinsheimer at the Department of Health and Human Services is available at (410) 786.4620.
Josh White, DPM, CPed New York City, NY Medical Director, SafeStep joshwhite@safestep.net
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Editor’s comment: PM News does not provide legal advice. The recently released Stark II provisions are contained in a 600 page document. In general, Stark II tends to be more liberal than Stark I in that it expands on the safe harbor exceptions to the self-referral prohibitions of the original law.
If a podiatrist is merely prescribing and dispensing a custom shoe or AFO, there should be no problem with Stark I or II.
Stark problems would arise if you prescribed a custom shoe and sent the patient to a shoe store owned by your wife, or if whomever you referred the patient to, sent you a kickback or any sort.
Since the Stark Laws are complex and situation dependent, the advice of legal counsel should always be sought when confronted with a potential Stark problem.
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