Were an Army Veteran’s Prosthetic Legs ‘Repossessed’ After a VA and Medicare Dispute?

Claim

Army veteran Jerry Holliman's legs were repossessed because the Department of Veterans' Affairs (VA) refused to pay for them.

Rating

Decontextualized

Reporting

On January 9 2020, an article about Army veteran Jerry Holliman and the repossession of his prosthetic legs after a payment dispute between the VA and Medicare was shared to Reddit’s r/nottheonion, a subreddit for news stories odd enough to sound as though they could be satire, but aren’t:

Army veteran has prosthetic legs repossessed after VA refuses to pay for them: "Medicare did not send me to Vietnam" from nottheonion

 

Comments addressed the summarized claim versus its details. One commenter asserted that the linked reporting was insufficiently detailed, making the described situation difficult to understand fully:

From the article, the vet did not ask for or get the legs from the VA. He got them from a private provider apparently without being seen at the VA. The VA has a prosthetics service at every VA med center and provides legs, arms, hands, wheelchairs, canes, walkers, hospital beds, urinals, scooters, enteral infusion pumps, etc, etc, etc.

But for the VA to pay for something you actually have to get it through the VA, either directly or after they authorize a community provider to get it. The VA does not pay random bills that show up in their mailbox — that would lead to excessive fraud waste and abuse — to ask taxpayers to pay the bill for health care the VA needs to have some process of accountability to ensure that the taxpayers are not being scammed or ripped off (not saying that was the issue here, but that is why the VA has policies and procedures).

It sounds like this poor guy was confused about the process, did not understand ‘how things work’. It would take investigation to learn why that was the case — whether the VA failed to provide him with the info he needed to get what he needed, or if he did not take advantage of the VA’s help at all. Who knows? not enough info in the linked article to decide this.

Linked in the original post was a January 9 2020 Newsweek article titled “Army Veteran Has Prosthetic Legs Repossessed After VA Refuses to Pay for Them: ‘Medicare Did Not Send Me to Vietnam.'” It began by indicating Holliman “claimed” his prosthetic legs were repossessed, and cited original reporting by the Clarion Ledger:

A decorated military veteran who served in Vietnam and Iraq has claimed that his prosthetic legs were taken away after the U.S. Department of Veterans Affairs (VA) would not cover the cost.

Jerry Holliman, 69, told the Clarion Ledger that he was in his room at the Veterans Home in Collins, Mississippi just a couple days before Christmas when a man walked in and took away his prosthetic limbs. According to Holliman, the VA said it would not cover the cost of the limbs, while Medicare said there’d be a copay required.

“Medicare did not send me to Vietnam,” Holliman, who received Bronze Stars in both wars in which he served, told the Ledger in an article published Thursday. “I was sent there by my country…with the understanding that if something bad happened to me, that it would be covered by the VA.”

Newsweek‘s information appeared to have been sourced in its entirety from reporting published the same day by the Clarion Ledger. According to that coverage, Holliman’s prosthetic legs were repossessed on December 23 2019.

That article began by reporting that Holliman had intended to move out of a veteran’s nursing home and regain independence after receiving prosthetic legs, but that the limbs were “repossessed” just before Christmas 2019:

The U.S. Department of Veterans Affairs wouldn’t pay for his prosthetic legs, Holliman said, and Medicare wanted him on the hook for co-pays. As Holliman tried to navigate what felt like a maze of paperwork, it felt like his country was forgetting him.

“Medicare did not send me to Vietnam,” Holliman said. “I was sent there by my country… with the understanding that if something bad happened to me, that it would be covered by the VA.”

According to the paper, Holliman obtained the prosthetic legs from a company called Hanger in August 2019, and at some point learned the “U.S. Department of Veterans Affairs would not pay for his prosthetic legs.” Parties involved (such as the VA, Hanger, the facility in which Holliman resided, and Medicare) were unable to comment on the story due to medical privacy laws.

The paper said Holliman “tried to raise the alarm” with nursing home staff, but also that Holliman understood the VA was the only entity who could make the decision. In that reporting, the outlet indicated Holliman was advised to “use Medicare” to cover the costs, but it wasn’t clear which parties advised which things.

It continued, suggesting that the prosthetic legs were repossessed after Holliman declined to sign unspecified Medicare forms. Holliman said the forms mentioned a co-pay for the limbs but not a total cost, and that Holliman refused in part because he believed the VA should cover the cost of the limbs:

Holliman said he was encouraged to use Medicare to pay for the prosthetic legs, but he was never shown a total cost, and the forms indicated he would have to pay a co-pay.

So he refused, never expecting what would come next.

On Dec. 23 [2019], an employee from Hanger came to the Veterans Home to see Holliman. Holliman said the man was adjusting his prosthetic legs, then asked him to sign some paperwork for Medicare.

Holliman said he declined because the U.S. Department of Veterans Affairs should pay for the legs in full … The man responded by taking the legs and leaving.

Newsweek‘s article was widely discussed on Reddit, but it was not as detailed as the original article from which its information was drawn. According to the Clarion Ledger, the same Hanger representative visited Holliman on January 2 2020 and returned the legs.

However, Holliman’s difficulties with retaining and using his prosthetic limbs was not yet over. Although he indicated the representative was friendly and acknowledged Holliman’s military honors, simply getting the legs back did not resolve the situation:

“He didn’t know that I received those [rewards],” Holliman said.

There was a problem with the legs, though. No adjustments had been made to them, Holliman said, and he can’t walk without one leg folding in on him.

“’You can have ‘em,’” Holliman recalled the man saying, “but they’re not going to do anything to them until the VA pays them.”

Initially, Hanger told the Clarion Ledger that it was unable to comment due to patient privacy laws, and a waiver from Holliman was required to further discuss the impasse over his prosthetic legs. Hanger spokesperson Meghan Williams eventually described a complex rigamarole during which the clinic maintained that it “does not take back prosthetic devices after final delivery to a patient has been made,” but that “final delivery … [is only fulfilled if] a patient has signed a verification of receipt that allows a claim for payment to be submitted to the applicable insurance payer.”

In other words, Holliman receiving and using the prosthetic legs was not considered “final delivery” because payment on the limbs was at least partially outstanding. Finally, the Clarion Ledger described a lack of resolution over Holliman’s legs and his desire to leave the nursing home. None of the parties involved  — including the VA, Medicare, and Hanger — commented on its resolution, citing medical privacy laws.

On January 9 2020, Clarion Ledger reporter Giacomo Bologna tweeted an image sent to him by Holliman’s son of the unadjusted legs:

 

As that report illustrated, obtaining the basic facts of the story was complicated — perhaps in no small part because people whose answers might prove unpopular could hide behind medical privacy laws. But the Reddit commenter quoted above hinted that VA procedure might be a factor in the payment dispute, and they claimed that the VA’s rules in part require going through the agency for approved devices and procedures:

But for the VA to pay for something you actually have to get it through the VA, either directly or after they authorize a community provider to get it. The VA does not pay random bills that show up in their mailbox — that would lead to excessive fraud waste and abuse — to ask taxpayers to pay the bill for health care the VA needs to have some process of accountability to ensure that the taxpayers are not being scammed or ripped off (not saying that was the issue here, but that is why the VA has policies and procedures).

Holliman said that he believed the VA should pay for his prosthetic legs, a sentiment clearly shared due to the article’s virality. The VA Prosthetics Handbook contained a section called “3.4. Provision of Artificial Limbs.” Sections A through C described the VA’s procedures for administration involving prosthetic limbs:

a. Artificial limbs, parts and repairs must be procured, fabricated and issued to eligible beneficiaries by prescription from a designated physician assigned to the Amputee Clinic Team or from the Prosthetic Representative in accordance with the policies and procedures outlined in VHA Handbook 1173.1, VHA Handbook 1173.2, and VHA Handbook 1173.3. Prescription for the initial prosthesis, and any change in the prescription, requires the involvement of the Amputee Clinic team physician, or in the case of a partial foot amputation, the podiatrist assigned to the Amputee Clinic Team. A prescription for a new prosthesis, or a change in the current prosthetic prescription, occurs in conjunction with an appointment in an Amputee Clinic.

b. These artificial limbs (appliances) can be procured from contract vendors where adequate appliance facilities are available, the time required to receive delivery of the appliance is not excessive for patients, and the prices charged for such appliances are reasonable. NOTE: VA Orthotic Laboratories with a certified prosthetist may also be used as a source in the fabrication of preparatory, temporary, and permanent artificial limbs.

c. Eligible veterans, as identified in VHA Handbook 1173.1, who have previously received artificial limbs from commercial sources, will continue to have their choice of vendors on contract with VA or their non-contract prosthetist, providing the prosthetist accepts the VA preferred provider rate for the geographic area. VA facilities with Orthotic Laboratories that have certified prosthetists, or facilities with access to a VA Laboratory, will provide eligible veteran amputees with the preparatory or temporary prosthesis and permanent limbs. NOTE: When the patient has achieved appropriate shrinkage and is ready for a permanent prosthesis, the preparatory or temporary prosthesis is replaced.

That particular handbook was long and detailed, and the word “excessive” appeared at least eleven times. Typically, it was used in conjunction with guidelines involving private vendors (possibly like Hanger). Section 3.5., “VA Source for Artificial Limbs Purchased for VA Beneficiaries,” holds:

a. The VA Artificial Limb Contract must be used as a primary source in custom fabrication for artificial limbs purchased for VA beneficiaries. However, fabrication may be from VA Orthotic Laboratories where adequate facilities are conveniently available, certified staff is available to patients and prescribing physicians, the time required for delivery is not excessive or will not result in prolonged hospital stay for patients, and the prices charged for such appliances are reasonable.

The VA also hosted prosthetics.va.gov for a battery of individual handbooks relating to myriad prosthetics (and a timeline of military prosthetics), all of which were download-only. Multiple, dense “handbooks” provided by the VA seemed a possible contender for the “maze of paperwork” which Holliman tried to navigate before obtaining the subsequently-repossessed artificial limbs.

One of several handbooks, timelines, guideline sheets, and fact sheets [PDF] noted the VA provided “prosthetic equipment,” highlighting a lack of available information in the story about Hanger’s status with the VA and the manner in which the prosthetics were prescribed and dispensed. Reading between the lines, it seemed possible both that the devices were not covered automatically by the VA, and that that information might not be obvious to a patient like Holliman until it escalates to a scenario like the limb repossession:

VA provides all clinically appropriate and commercially available, state-of-the-art prosthetic equipment, sensory aids and devices to Veterans that cross the full range of patient care. Such items include: artificial limbs and bracing, wheeled mobility and seating systems, sensory-neural aids (e.g., hearing aids, eyeglasses), cognitive prosthetic devices, items specific to women’s health, surgical implants and devices surgically placed in the Veteran (e.g., hips and pacemakers), home respiratory care, recreational and sports equipment. In addition to providing devices, PSAS also administers the following three unique benefits to assist Veterans and Servicemembers with disabilities.

In the end, no one involved seemed to deny some basic facts — that Holliman obtained prosthetic legs in August 2019, and that Hanger “repossessed” the prostheses on December 23 2019 (returning them without adjusting them on January 2 2020). Holliman contended the VA ought to pay for his prosthetic legs, and available VA guidelines indicated that prosthetics like legs are covered under their benefits — so long as the devices are approved of and/or dispensed by the VA. Details regarding the dispute around the VA, Medicare, and Hanger were unavailable due to privacy laws, making the claim broadly decontextualized.

As of January 9 2020, Holliman’s prosthetic legs were returned, but without the necessary adjustments he needed to utilize them and move out of the nursing home.

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