As a Diabetic patient you should be cautious when procuring therapeutic shoes and inserts under the Medicare Therapeutic Shoe Bill to insure you are receiving the level of service intended. The evaluation, measuring, casting, and fitting of these devices in a clinical setting is a process that involves considerable personal contact between the practitioner and the patient. This is as it should be. Care is taken by the provider of these devices to insure proper fit and function. Patient education and follow up is done in the office. Adjustments are often needed after initial fitting. The potential complications which can follow improper fitting of these devices can be serious. Modifications and adjustments to the shoes and inserts are sometimes needed. These can only be done by someone with the proper training and equipment.

There is a lot of money to be made in the diabetic shoe business by high volume, minimal patient contact operations. These companies often use the Internet, to solicit new customers. They may send someone to measure and cast you - they may not. Often the shoes are mailed to you to try on yourself and you are expected to call them if there are any "problems." These businesses are receiving the same reimbursement from medicare for your care that the certified and licensed professional receives for spending time with you in his or her clinical office. But, you the patient are clearly not receiving the level of care intended by the Medicare therapeutic Shoe bill.

Diabetic shoes are sometimes sold as a sideline in a retail establishment such as a pharmacy. These companies usually do not have a any fitting stock or the necessary facilities for private and comprehensive evaluation and fitting. Rarely will they have the equipment needed for modification and adjustment. Their personnel may lack the training to be considered a "qualified individual" under the Medicare therapeutic Shoe Bill. In short, these businesses have not made a significant investment in patient care, and diabetic shoes and inserts are in effect, just another retail item on their shelf. Once again, there is a lot of money to be made when the provider's investment is confined to a few display shoes and a measuring stick, but the question must be repeated: "Are you receiving the level of care that Medicare intends?"

The following quote is from the LMRP for Therapeutic Shoes for Persons with Diabetes (L11515) on the Region B Medicare Durable Medical equipment Website (with the full text available on the Internet at the link above. It specifies the professions that are trained to fit therapeutic shoes.

"The particular type of footwear (shoes, inserts, modifications)which is necessary must be prescribed by a podiatrist or other qualified physician, knowledgeable in the fitting of diabetic shoes and inserts. The footwear must be fitted and furnished by a podiatrist, or other qualified individual such as a pedorthist,orthotist or prosthetist. The certifying physician (i.e., the physician who manages the systemic diabetic condition) may not furnish the footwear unless he/she practices in a defined rural area or a defined health professional shortage area. The prescribing physician (podiatrist or other qualified physician) can be the supplier (i.e., the one who furnishes the footwear)."

Medicare does not intend to provide free shoes and inserts to all diabetics. The physician responsible for your primary diabetic care must certify additional medical complications, attesting that you really need special shoes. Prefabricated inserts are sometimes indicated- not every patient needs the custom made inserts. The custom inserts cost Medicare and the tax payer more and of course provide additional income to the provider. If the additional cost is not justified, this is what many would call Medicare abuse. Some outfits will bill medicare on your behave for "custom diabetic shoes" while only providing off the shelf shoes slightly modified or fitted with custom inserts. This is what many would call Medicare fraud.

The state of Illinois and others have laws which also appear to provide direction as to who is qualified to dispense and fit therapeutic shoes in their respective jurisdictions. Orthotic, Prosthetics, and Pedorthics Act - Illinois

Yes, be cautious when it comes to therapeutic shoes and inserts. Your health and your pocketbook is involved.

"Diabetic Shoes" "Diabetic Inserts" "Medicare Therapeutic Shoe Bill"