Last week you may have heard about the Medicare fraud scheme in which the owner and vice president of a Detroit-area medical clinic were convicted in a $23 million scheme—submitting $23.2 million in claims to Medicare for occupational therapy and physical therapy that were never provided to beneficiaries.
AOTA reported on the story on AOTA.org and urge all members to educate themselves on the severity of committing fraud and to know how to appropriately report suspected fraud when necessary.
We want to know what you think about this case and about Medicare fraud, waste, and abuse in general. Do you have any resources to share? Any opinions on this case in particular? Any advice on reporting fraud?
The mantra I remember from my past is "does it take the knowledge and skills of an occupational therapist?" Documentation standards for home care and nursing homes were stringent. with the real risk of retroactive denial and fines.I find acute care to be self regulated and much harder to defend should that question be posed? Lucky for PT walking, is almost always a meaningful occupational activity with with health benifits.Pulling theraband with IV's in your arms?
It is unfortunate that there are more and more people out there that try to find the easy way of making a buck at the expense of the general public. There have been many similar cases to this one through the years. As a practitioner it is important to make sure you are aware of what you are billing and have documentation to back it up so that you have the proof of services provided. With home health I would definitely get a signature from the patient at the time of the visit on your paperwork as an added safeguard against any allegations. I know that many clinicians do not have access to the final bills for a patient but any irregularities or practices that don't seem quite right should be questioned. Your supervisor or company should be able to explain items to you that you don't understand. If they can't, you might have a problem or if they avoid the topic you might have a problem. As far as reporting goes, it is each of our responsibilities to report Medicare fraud and abuse first through the proper channels at work and then higher up if no resolution comes from the initial reporting.
Read this today about more indictments in Medicare fraud for clinics billing fraudulent physical therapy and occupational therapy. Feds charged 94 people for a combined $251 million in phony claims.
I have work as a travel therapist, and my last assignment I saw, what I believe to be a form of Medicare fraud. I ended up quitting my contract early because I did not want to be affiliated with the therapy company. Any advice on if I should take further action? I'm torn, because I don't have physical proof??
Setting: 5 SNFs
What I saw: The rehab company scheduling 12-16 hours of therapy minutes on everyone's schedule forcing people to do groups and concurrent therapies, whether it was indicated or not. PTA who was the VP of the company dictating treatment to a DPT. People doing group (97150) and billing as individual treatments. Mixing Med A and Med B patients together, calling it concurrent, and billing as individual treatments for the full amount of time. Misuse of the estim code (attended vs unattended). Therapists billing for nonbillable time (set up time, transportation of pts, adding minutes to their total session to make the desired RUG level, and trying to talk a pt into therapy if they refused).
What I did: Provided a handout from AOTA on the differences between concurrent and group therapy to the supervisor. Provided education to other staff about differences. Called the CEO (who was NOT HAPPY with me and basically called me a liar).
Is this worth pursuing? Or do I let it go??
can you contact the medicare intermediary and ask their reporting process??
I remember years ago, looking over my father's EOBs and realizing the O2 supplier was chargng medicar for items tey did not provide ( my dad was out of state during that time period) and charging for equipment never provided.
When I contacted Medicare with documentation of the errors ( to put it politely) they said it was too small of a claim to pursue!
jan menke
Janet Menke OTR/L, CLVT