Fraud prevention

Too good to be true?

Discounts on orthopaedic footwear may cost benefits plans money

Who can blame someone for jumping at a good deal?  In fact, usually plan members are encouraged to shop around and find the best price possible in order to save their benefits plans money.  But you may not realize that in some provinces, incentives offered by podiatrists, chiropodists and pedorthists contravene the code of conduct for licensed orthopaedic practitioners.  And by accepting those offers, plan members could be costing—instead of saving—their group benefits plans money.

 

Podiatrists and chiropodists are regulated by provincial Colleges or Associations, while pedorthists must adhere to the guidelines set by a national body, the College of Pedorthics of Canada.  Each College/Association is a regulatory body whose mandate includes certifying its members and maintaining standards of practice.  In provinces such as Ontario and Manitoba where an abundance of suppliers has created intense competition to attract new business, the provincial and national colleges have seen the need to set standards that prohibit the use of coupons, discounts, gratuity offers, special benefits and prizes.  Licensed practitioners who offer these kinds of incentives to clients are defying the standards of practice and putting their credibility (and perhaps even their licenses) at risk.  They may also be charging plan members more because the price of the incentive could actually be hidden in the price of the orthotics.  When plan members pay higher prices, their coverage is exhausted faster, as is the plan sponsor’s benefits budget.  This has the potential to lead to a decrease in future coverage.

 

Plan members can help control costs and preserve coverage by being informed and staying involved.  Plan sponsors are important players in plan member education, so encourage plan members to consider the following guidelines when shopping for orthotics.

 

These regulators can provide more information on standards of practice.

Province

College/Association

 

British Columbia

British Columbia Association of Podiatrists (BCAP)

(604) 602-0400

www.foothealth.ca

Alberta

Alberta Podiatry Association (APA)

(780) 453-5883

www.albertapodiatry.com

Saskatchewan

Saskatchewan Association of Chiropodists (SAC)

(306) 691-6405

Manitoba

College of Podiatrists of Manitoba (COPOM)

(204) 942-3256

www.copom.mb.ca

Ontario

College of Chiropodists of Ontario (COCOO)

(416) 542-1333 or 1-877-232-7653

www.cocoo.on.ca

Quebec

Ordre des podiatres du Québec (OPQ)

(514) 288-0019 or 1-888-514-7433

www.ordredespodiatres.qc.ca

New Brunswick

New Brunswick Podiatry Association

(506) 632-9422

 

Submitting an orthotics claim?  Be sure to include:

 

  1. A completed Extended Health Care claim form
  2. A copy of the recommendation or referral from a licensed physician, podiatrist or chiropodist, including the medical condition requiring the use of the orthotic appliance.
  3. Copies of the biomechanical examination and gait analysis performed (available from your practitioner).
  4. A description of the process used to create the orthotics, including the casting technique and raw materials used (also available from your practitioner).
  5. The receipt confirming the orthotics have been dispensed and paid for in full.