Fraud, Waste and Abuse in Skilled Care: A Two Part Series

In Physical Therapy Articles, Reimbursement Trends and Strategies by EditorLeave a Comment

Today’s guest post comes from Aaron Hackett, A Witty PT, on a topic that many are aware of, but few are brave enough to explore the options when faced against the challenge.

Fraud, Waste and Abuse in Skilled Care (Part 1)

Fraud, Waste and Abuse (Part 2): Q & A with an Attorney

A Big Problem in Physical and Occupational Therapy

Part 1

This new year 2020 has every physical therapist, occupational therapist and speech therapist on pins and needles as to how clinics and rehab centers are going to stay open.  Opinions, rumors and even conspiracy theories abound in regards to the major payment changes Medicare introduced late 2019 and just recently January 1st 2020 (Currently referred to as PDGM and PDPM ).

These changes frightened many rehab companies to mass layoffs and salary reductions for PT, PTA, OT, COTA and other rehab staff.  These layoffs came with little to no warning nor any waiting period to see how all this would play out. The ethics of these companies have certainly been in question due to their shotgun reactions.

The purpose of this article is not to delve deep into the history and workings of CMS nor is it to fan the fires of rumors and theory as to what is going to happen.  This article is about solutions and how you can be a part of them. Before we get to those solutions I do want to give just a touch of perspective for better understanding as to the solution presented shortly.

Really, I could sum it up with “Well, Medicare did warn us!”.

I graduated with my doctor of physical therapy degree in 2006, prior to this I was working as a PT Aide for a large hospital based PT clinic.  This was back as early as 2001. Back then managed care was just making an entrance into physical therapy. As an aide, one of my tasks was to track the various forms health plans were now wanting, including Medicare 700 and 701 forms, for the PT team I was part of.  Each year at this clinic we would get additional training on small changes to these forms and other requirements. In these trainings, there was always some education about fraud in healthcare and physical therapy .  Each year that training became more involved and more specific.

Once in PT school and even in the first few years out of school I recall starting to hear how Medicare was going to ramp up audits (here is an article from 2006 talking exactly about this) and investigations.  Payments started being capped. They started requesting functional reporting. We fought about the CAP. They mandated functional reporting. Back and forth with each new policy.  Each time more training, more warnings about fraud, waste and abuse!

All this while Medicare increased the use of these audits and investigations.  They find more and more evidence of fraud in rehab care. Why? Could it be because so many clinics and facilities would find anyway they could to maximize billable units despite proof of needed care? Could it be that Medicare started to see that there is no way every patient in one facility needed the maximum allowable care?

Continue reading Part 1 and Part 2.

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