Reimbursement Guidelines
Medicare has some very specific rules that we all have to follow in regards to performing treatments and submitting the billing for time spent with patients. Ever since the advent of PPS there have been many different definitions, or ways people try to read between the lines, to make the rules bend to their liking.
One fact that has always been true, without question, is what constitutes fraud. Billing for treatment time not actually spent with the patient, billing for treatment not given, and billing excess time for groups and co-treats are probably the ones most abused. I'm sure there are many more I can't even think of, but one thing I do know is being caught for Medicare fraud will cost you your license, a possible fine or maybe even jail time.
Reading through a few blogs this past week, I found a few entries by some people concerned with the actions of another therapist they know. It seems like some therapists have forgot the code of ethics they agreed to abide by. I see one entry where a therapist has been coming to work, seeing their caseload of patients for about 15 minutes each, but billing them for an entire treatment. Another entry from the blogs is one therapist who works about 3 hours, bills for an eight hour day, and then heads off to work for another company. Either of these are cases of classic fraud, and when a Medicare audit is done I'm sure this will lead to some corrective action for the guilty parties. Therapists who work in such a poor ethical manner are not only stealing from their patients, but are probably stealing a job from another therapist.
However, my other concern here is for the people who are aware of the fraud happening. Being aware that someone is committing fraud but doing nothing about it makes you just as guilty. This too can cost a person their license, subject you to fines, or possibly lead to some time in jail. None of these are worth the risk of covering up for someone who is cheating the system.
On top of any of these concerns though, is the fact that scenarios like this is what led us into the tight reimbursement guidelines we have today. In the past, stories like the group who used to assemble their 12-18 patients in a therapy room, pass modalities around for 2 hours, then leave and bill this as 8 units of therapy for every patient was one of the abuses that caused Medicare to change the rules. New cuts are already being talked about, and our field is already tough enough to remain profitable in. If you or anyone you know is guilty of fraudulent billing, you'll be the ones to blame when the new cuts make things tougher. However, I'm sure you'll also be the first ones to whine too.
Until next time, hope all your thoughts are good,
Tim