Recently I was scanning my FaceBook feed and saw a query from a group member hoping to find a clinic that provided “free shoes with orthotics”.
As a veteran foot care professional, these offensive words leapt off the page at me like a neon sign. I know these shenanigans have been going on for a long time but this time it sparked more irritation than usual. I think it’s because of the openness of the enquiry about committing fraud and the fact that “friends” were answering her!
So what the heck? Surely discerning adults know the difference between using their insurance for the purposes of necessary medical treatment versus sporting the latest footwear.
“Pernicious insurance abuse has apparently rendered fraudsters oblivious to their crimes and our population, as a whole, desensitized to the deceit.”
About 20 years ago this issue was just starting to gain traction amongst some of the more “creative” clinics. A variety of factors, from interloping side-hustlers to unscrupulous laboratories and regulatory laxity conspired to create stiff competition in the orthotics area that slowly but surely spread this practice of “free shoes” (covered by your insurance) throughout the land.
“Free shoes” was like the tiny red rash that spread from the web of the baby toe to include the foot but now the fungus has spread right up to the crotch and cannot be ignored a moment longer!
Fraud of this nature requires complicity between the policy-holder and the supplier (clinic/practitioner). Since most insurance policies explicitly state requirements such as “orthopaedic shoes only” or “modified footwear to accommodate a foot deformity”, both patient and practitioner know perfectly well that this year’s on-trend fashion shoe is neither orthopaedic nor medically necessary.
If you find yourself amongst the hermitic few who have no idea what I’m referring to, then let me help. Your Spidey Senses should be tingling if:
many of your co-workers go to a particular clinic where they include “free” shoes with orthotics
the clinic does not have a qualified foot care professional on staff
Pedorthist/Orthotists, Chiropodist/ Podiatrists are the ONLY qualified foot care professionals so it behooves you to see one of these professionals
the clinic offers to provide you a receipt for orthoses but gives you shoes instead
the clinic offers to bill your insurance company on your behalf so you don’t know what they billed
Lest you think I am anti-shoe. I am not!
Proper footwear can be an important part of a treatment protocol for certain medical conditions. When fitted, modified and dispensed by a qualified foot care professional, shoes can mean the difference between functioning well or not at all.
“Contrary to the personal opinions of many people however, there is no inherent right to maximize one’s plan benefits to include shoes without medical necessity.”
Here’s what your free shoes could cost you:
if a clinic is willing to give you a “free shoe” they are cutting costs somewhere and that “somewhere” is likely a cheap shoe insert in lieu of a proper custom-made device
if you get caught participating in fraud, an insurer may take some of the following measures:
require you to reimburse the falsified claim
terminate your coverage
notify your employer of the fraud and you may end up losing your job
depending on the extent of the fraud you may be investigated by policing authorities and end up in jail
Does any of this sound like a reasonable risk to take for the sake of saving $150 on shoes?
Might I suggest a sensible approach?
make an appointment with a proper foot care professional if you have lower limb issues that may be a result of poor foot biomechanics
speak with your family MD about making a referral - they have often vetted local foot clinics
understand the requirements of your benefits if you do need orthoses and/or shoes
rebuff any suggestion of bundling products or product substitutions if this is posed to you because you have medical benefits
“The cautionary tale is to avoid cliffs by not running with the lemmings.”
Here are some interesting articles/sites on this topic.
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