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  • Top SNF Therapy Provider Settles DOJ Lawsuit for $125 Million

    The US Department of Justice (DOJ) announced that the nation's largest nursing home therapy provider has agreed to pay $125 million to settle a DOJ lawsuit that alleged the company engaged in a "systematic and broad-ranging scheme" to increase Medicare reimbursements by submitting false claims for rehabilitation therapy.

    RehabCare Group Inc, RehabCare Group East Inc, and parent company Kindred Healthcare will pay out the money in response to allegations that they violated the False Claims Act by "providing unreasonable and unnecessary services to Medicare patients," and that they "led … SNF [skilled nursing facility] customers to submit artificially and improperly inflated bills to Medicare that included those services," according to a DOJ press release. RehabCare contracts with more than 1,000 SNFs in 44 states to provide rehabilitation therapy.

    The alleged violations include:

    • Placing patients in the highest-possible reimbursement levels, regardless of determinations made through patient evaluation
    • "Boosting" the amount of reported therapy during "assessment reference periods" and then providing less therapy to those patients outside of those reference periods
    • Scheduling and reporting the provision of therapy, even after the patients' therapist had recommended discharge
    • Shifting minutes of planned therapy among disciplines "to ensure targeted therapy reimbursement levels were achieved, regardless of the clinical need for therapy"
    • Providing higher amounts of therapy near the end of a therapy measurement period to maximize payment
    • Reporting time spent on initial evaluation as therapy time rather than evaluation time
    • Reporting that skilled therapy had been provided "when in fact the patients were asleep or otherwise unable to undergo or benefit from skilled therapy"
    • Reporting estimated or rounded minutes of therapy rather than actual minutes provided

     

     According to DOJ, the settlement is also linked to 4 other settlements with individual SNFs for their roles in submitting false claims of therapy provided by RehabCare. Those payments range from $3.9 million to $750,000.

    The $125 million RehabCare settlement is the result of a whistleblower lawsuit brought to the DOJ by APTA member Janet Mahoney, PT, DPT, and Shawn Fahey, an occupational therapist. Both worked for RehabCare.

    SNF billing practices began making headlines late last summer, when the Wall Street Journal published a report outlining the findings of its study of the use of "ultrahigh" therapy hours, and resurfaced in October when the Office of the Inspector General of the US Department of Health and Human Services (HHS) issued a report highly critical of SNFs. That report was in turn the subject of a New York Times article on the issue, an article that prompted a letter to the editor from APTA President Sharon L. Dunn, PT, PhD, OCS, published in the Times.

    In the DOJ press release, Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the DOJ's Civil Division, says that the scrutiny will continue.

    "Medicare beneficiaries are entitled to receive care that is dictated by their clinical needs rather than the fiscal interests of health care providers," Mizer said. "All providers, whether contractors or direct billers of taxpayer-funded federal health care programs, will be held accountable when their actions cause false claims for unnecessary services."

    Helping physical therapists and physical therapist assistants understand their obligation to eliminate fraud, abuse, and waste is the central idea behind APTA's online Center for Integrity in Practice—a suite of resources to support care based on patient need and clinical judgment.

    Comments

    • I hope this is a wake up call for all rehab providers in this setting.

      Posted by Kathleen Clarke on 1/13/2016 7:11 PM

    • It harms all in health care when a organization, I also work for RehabCare, abuses the system with such a seemingly comprehensive strategy for increasing payments received. I applaud Janet and Shawn for bringing this practice to light.

      Posted by Dan Spence on 1/13/2016 9:19 PM

    • I left this company for these kinds of reasons.

      Posted by Eric Mace on 1/13/2016 9:39 PM

    • Ok, I have never worked for RehabCare. But I have worked for several SNFs, both directly and through contract companies in the last 20 years. You want to know why I won't work SNF? Because these problems are endemic to the entire NH industry and not specific to RehabCare. They make me sick, and I would rather leave therapy than go back to working with these expectations: According to the Department of Justice, "Specific charges: The alleged violations include: ◦Placing patients in the highest-possible reimbursement levels, regardless of determinations made through patient evaluation ◦"Boosting" the amount of reported therapy during "assessment reference periods" and then providing less therapy to those patients outside of those reference periods ◦Scheduling and reporting the provision of therapy, even after the patients' therapist had recommended discharge ◦Shifting minutes of planned therapy among disciplines "to ensure targeted therapy reimbursement levels were achieved, regardless of the clinical need for therapy" ◦Providing higher amounts of therapy near the end of a therapy measurement period to maximize payment ◦Reporting time spent on initial evaluation as therapy time rather than evaluation time ◦Reporting that skilled therapy had been provided "when in fact the patients were asleep or otherwise unable to undergo or benefit from skilled therapy" ◦Reporting estimated or rounded minutes of therapy rather than actual minutes provided"

      Posted by Bryan Gibby, MSPT, CWS on 1/13/2016 9:47 PM

    • As an employee of Rehab Care working in IRF, I always feel the pressure to see pt's even when it goes against good clinical judgement. Management tell us to bill only one unit for eval and the remainder of the time toward treatment. They admit pts to the unit that were assessed by other therapist to have no rehab potential. Clearly Rehab Care's problem extend beyond SNFs

      Posted by I'm afaird to say on 1/13/2016 10:03 PM

    • I was a contractor for three years and I cannot tell you the amount of fraud that I saw at so many facilities. I was calling my Medicare fraud rep way too often for my taste with each facility I went to. It is disgusting that supervisors threaten therapists careers and bully them into these unethical practices when many therapists are the breadwinner for their home and needs not only the pay, but their insurance and benefits. Should they work somewhere else? Yes. Is that easier said than done? Yes. When I saw more and more CEU offering for "Ethical Practices in Skilled Nursing Facilities" and "How to handle your supervisor when they ask you to maximize the billing," that was when things went downhill. It's a very disappointing site for me to see so early in my career…

      Posted by Jackie Brenner on 1/13/2016 10:14 PM

    • Whereas it is true that the pressures are extraordinary, in the end, it's the individual therapist's responsibility to do the right thing. APTA's Center for Integrity in Practice is a solid step in the right direction.

      Posted by Richard Shutes -> CHR[@ on 1/14/2016 7:55 AM

    • It is a shame that there are providers like this that give SNF rehab a bad name. I work for a large SNF corporation and am proud to say we don't have these problems. We do thing right.

      Posted by Matthew on 1/14/2016 8:08 AM

    • I was forced to leave employment in SNFs due to the pressure exerted on me to participate in these types of practices.

      Posted by Monica Moskowitz, PT on 1/14/2016 8:18 AM

    • In the end, it's the therapists and assistants doing a lot of these things. We can't let productivity standards or corporate pressure dictate clinical practice. It's our license on the line.

      Posted by Tyler Hassinger on 1/14/2016 8:59 AM

    • How is it that therapists from all thee disciplines (PT, OT, SLP) could allow this to happen on such a massive scale? Perhaps our educational programs need a stronger emphasis on ethics.

      Posted by John Hilson on 1/14/2016 10:44 AM

    • This is a great example of how we eventually become the Providers of Choice for Movement Dysfunction...Adhering to the definition of what constitutes a "Professional". Policing our own and assuring legal and ethical standards and maintained.

      Posted by Rebecca Crocker, PT, DPT on 1/14/2016 12:48 PM

    • I experienced it first hand as well when I worked for rehab care in a safe It was located in Berlin ,MD

      Posted by Cristina madarang on 1/14/2016 7:03 PM

    • I applaud the courage of the whistleblowers. How long did it take for DOJ to hand out ruling from time that the whistleblowers came forward?

      Posted by Maria Lee on 1/14/2016 8:52 PM

    • I use to question the billing that therapy submitted to Medicare for my mom at kindred health care. Glad there was a whistle blower. Medicare gets ripped off to much!

      Posted by Pamela Walton on 1/14/2016 10:19 PM

    • Kudos to Janet Mahoney, DPT and Shawn Fahey, OTR! Hate to read and label them "whistleblowers" kind'a like a negative term, because this is such a positiive action. it is about time. I work in acute in-patients and I just shake my head when sometimes I find out that my former patient who was ambulating 150' with just min-to-CGA without a device is placed on a 7 days/4 wk program and seen by 2 disciplines.

      Posted by MINERVA MEEKER on 1/15/2016 2:49 AM

    • It's good to know that these issues of Medicare abuse and fraud are finally being taken seriously. I'm a PT and have worked at different facilities and companies that contracts SNF and Home Health Agencies. Working at SNF facilities, we are always being pressured to get an 85 percent productivity. I used to travel to different towns to supervise PTA, performed evaluations and discharges. PTA's are usually the facility supervisors or Directors of Rehab and has the one to decide either to extend or d/c pts. Often times PT's are usually being used to supervise PTA for these purposes. For fear of losing our job and hours, we have no choice but to follow what our Directors or supervisors wants ask to do even if its against our will. I remembered, I always get in trouble for arguing with PTA's, and our company supervisors because I'm always against of this Medicare abuse and using us PTs. I love what I do and very proud to be a PT. I enjoyed working with elderly pts and tried to do my very best to get them better. I have high respect and love for elderly pts. But being a PT I also know if they have reach their limitatios and functional rehab potential. Sometimes some of our elderly pts feels like they are being pressured and force to do Rehab because they are being threaten to pay out of pocket if they don't want to agree to rehab. I know this for a fact because sometimes I attended meetings and know what a Social Worker or manager can do in the nursing home. I know Rehab Care is one of the worst but it's not the only one. To me all of the SNF's facilities and Home Health agencies are guilty of these abuses. I hope that for being honest and sharing my thoughts and experience for working in a SNF facilities and home Health Agencies will not causing trouble to all Rehab professionals that works in SNF or Home Health Agencies. Thank you.

      Posted by Alysa on 1/15/2016 1:28 PM

    • I left this company after being hospitalized with with extremely high blood pressure and heart rate that was directly related to the constant pressure from my direct supervisor to make budget. Money was always the bottom line, not patient care. I retired and let my license lapse because I couldn't face going back to work under these types of situations.

      Posted by Kandy Brewer on 1/15/2016 3:02 PM

    • It is especially bad for us Registered Therapists in the SNF. We are just expected to eval patients. We are no longer able to treat patients. If there are no evals, you get 3 -5 hours for an 8 hour day and you spend the rest of the time doing non-billable documrntation. Assistants on the other hand are getting overtime because the company is trying to save money. The evals that you are expected to do are on Part B Patients that have not declined. When you refuse you basically go home with no hours.Trying to start my own business because of the way we Registered therapists are being treated.

      Posted by Moriam Kadiri on 1/15/2016 3:12 PM

    • won't ever post my full name here for employment reasons. i too wonder how long this case took to get litigated. i can only imagine how tough it must've been for the whistleblowers for their current and future employment. i used to work for snfs on contract too, 2.5 years to be exact. was so glad that i moved to an inpatient setting, despite the lesser pay in such settings, as there are lesser fraudulent situations there compared to snfs. i remembered having to do "screens" on residents to pick them up for therapy once the caseload goes down, and force the highest RUG levels on pts that are deemed appropriate for hospice. even the residents themselves know how to manipulate the system of when they can be picked up by therapy. i have friends who would rather stay in the snf system due to the huge pay they get there, and just turn a blind eye to the unethical practices to keep earning $90k and up/year. heck they would even brag about their lavish lifestyles, luxury cars, fancy homes, etc because of their work in snfs. sometimes, i do get tempted at working in snfs again since i need to start putting more for my retirement, but then again, i think about all the ethics issues in snfs and how hard it is to find bosses/employers who are ethical about such things while balancing the business aspect of it all.

      Posted by minh on 1/15/2016 3:55 PM

    • and i hope this shakes up the whole rehab industry, not just the snf setting. even though i work in inpatient setting now, there are still some amount of unethical/fraudulent practices there as well: forcing pts to discharge home instead of snf even when they are clearly being documented as needing snf care for safety (to avoid not being reimbursed due to snf discharge), admitting pts from acute care that are obviously not yet ready for rehab (causing them to get readmitted to acute care or dying in worst cases), admitting noncompliant/combative/uncooperative pts, forcing therapists to document "tolerance" instead of "refusal" when a pt refuses to cooperate even without signs of illness/fatigue/pain, not hiring enough therapists to sufficiently cover the caseload and preferring to use group therapies (thank God for Medicare forcing the facilities to use individual treatments and cutting down concurrent/group treatments). it was ridiculous when our bosses used to say "oh it's hard to find therapists" to get more coverage prior to medicare requiring individual treatments. but now they're able to find therapists after the medicare change. YEAH RIGHT!

      Posted by minh on 1/15/2016 4:04 PM

    • I think most patients in SNF need the Ultra High level of therapy. The patients are there FOR THERAPY in most cases. If the patient is seeing both OT and PT that's only a 60 minute treatment for each 6 days a week. If they have SLP too it's even less. With the pressure for shorter lengths of stay with successful discharges (no readmissions) there's a lot to get done. I'm always surprised when therapists feel can't come up with 60 minutes worth of skilled services that can be provided in a whole day (maybe not at once). These patients are never straight forward and have multiple comorbidities- if they don't, they go home instead of SNF. I find the therapists who can't get 720 minutes a week of beneficial services done on most patients are not doing thorough evaluations or treatment plans based on evidence based practice. This is just as unethical as providing more than is needed. We have a lot to offer; let's not sell ourselves short. By the way, we need to prove it too, so let's make sure we are using standardized assessments that are validated across the post acute care setting to show the VALUE we are providing for those Ultra High payments.

      Posted by Tracy on 1/15/2016 5:33 PM

    • I have worked for multiple snf companies including hallmark, on pointe, genesis, and Rehabcare. The allegations made against rehab care are more of a standard of practice across the board. It was always toted that the therapists make the decision on patient care levels but from my experience it was all lip service. Therapist are help to minutes and productivity despite actual patient needs. This was most prevalent in genesis buildings from own experience. I have since separated myself from these illegal practices!!

      Posted by Anonymous on 1/15/2016 7:10 PM

    • I sincerely appreciate the efforts of Janet Mahoney, DPT and Shawn Fahey, OTR.

      Posted by SARVARKHAN F PATHAN on 1/15/2016 8:53 PM

    • This has happened at every job I have had as an OT. I know RehabCare is not the only one. I think Medicare forces these practices because they are the ones who pay the skilled nursing facilities for the hospital stays of our patients. How can the facilities get covered for all the expenses of a patient if they don't get reimbursed from Medicare? So the higher the category the better the reimbursement. Of course we are going to try and hit the highest possible. I feel people do their best to be ethical. However, it is also a system that is broken or better yet like a sticky spider web that many are caught in and it's hard to get out. After all we need to work and to help our patients. I hope there can be another way. Maybe this can be an inspiration for a whole new regime.

      Posted by Anonymous on 1/15/2016 10:17 PM

    • I was a Program Manager for RehabCare and have since transitioned to another company because our building had a change of management who contracts with another therapy company. I chose to stay at my workplace. Perhaps this is more of a problem with the PPS billing system than a dirty company. I know that it is pretty sad and frustrating when a patient is doing so so so good and they have one bad day. It just so happens to be on day 8 of their stay when the PPS window closes.... And you are stuck! What do you do? You miss the RUG by 8 minutes??? I know I manage my team very ethically (i. e. Allotting 90-120 for evals/tx and constantly touching base about appropriate RUGs) but what I notice, as a manager, is the 15 min eval or rounding to the nearest 5 is more of an individual habit of the therapists. I personally have never been pressured by the RehabCare higher ups or have I pressured the team on these things. I am wondering if therapy billing should go to a billing system where you get paid per unit like Med B.... Call a spade a spade. I'm sure it will bring about new challenges, but it may help therapists stick together. Remember, managers are usually therapists too.

      Posted by Alison on 1/16/2016 8:56 AM

    • I have worked for 9 years with RehabCare as a Program Manager and can tell you I ran an ethical department AND made the company money. I think instead of blaming the company for being unethical we all need to take a look at ourselves and the Medicare/insurance reimbursement system. First, how many of you called the compliance hotline to seek help? You can be anonymous. Were you willing to leave your high paid job to go to a lesser paying job like at a hospital? I haven't seen anyone complain about how much money we are paid! Or think outside the box with treatment? Gain extra knowledge to better treat your population? Now let's look at the reimbursement system...does my patient really benefit from being with me while I read and write a note? Medicare must think they so. They think it doesn't take my THERAPY SKILLS to do this unless my patient is present. Can a nurse effectively read or write a therapy note? Medicare doesn't think treating the whole pt is a skilled therapy. I can't bill for getting to know my patient and build a level of trust the individual may need to properly participate at a confortable level. Talking to the Dr, nursing or family also isn't skilled right ?As for RUGS categories...another resticting Medicare game. Before PPS we could truley give each patient the time they needed. RehabCare taught me that the patient determines their RUG score, not the therapist. If the pt needed needed high minutes and can't tolerate it all in one sitting then you divide minutes according to what discipline was most needed. The PATIENT'S MEDICARE DOLLARS were used according to their specific needs. And if that meant morning and afternoon split session within each discipline then that's what we delivered. Our patients were treated 6-7 times a week when they needed it. With insurances and Medicare pushing for a shorter length of stay patients often benefited from weekend therapy. So...before I end my rant let me ask you to look inside yourself and ask how often YOU focused on fighting "the system" instead of working on fall recovery, teaching patients how to care for pets they may have at home or community integration? Or working on a scensory/task program or other individualized programs for low vision, proper positioing to promote comfort, increase skin integrity or contracture management in bed and wheelchair or train staff with your med B caseload? We need to work with staff to offer a resident something instead of telling them to sit down a million times a day. The resident is often from an era where they rarely sat down. You can bring purpose and quality to anyone's life with your SKILLED therapy!! Residents are in a SNF because they need our help. But wait...no reimbursement for a screen...doesn't that take our skill too? Can a nurse or dietitian determine skilled, reasonable and necessary? I implore you, look inside yourself to ensure that our professions can continue and give our patients ALL of our skills. The payment sysyem and most companies will continue to push us for more. It's a business after all. Make it your business to do what's right and give ALL of our patients what they deserve and if that fails...stick your neck out and make that Compliance call.

      Posted by Amy Kuhlman on 1/16/2016 2:14 PM

    • Exactly what happens in Govt. Run healthcare. They say if you say this you will get paid that. Heck I have had threats toward my license and m6 physical wellbeing for not being willing to commit blatant fraud. Healthcare needs to be out of a government system where you get paid by the business you attract based on good work and reputation.

      Posted by mn on 1/16/2016 3:28 PM

    • The later commentator says it all. The therapist is justifying how to meet the RUG levels by distributing the minutes to disciplines perceived as most needed by the patient and not directed by the needs of the same. The therapist describes the means to achieve the end forgetting that the approach is one that aims at maximing re-embursement than meeting the real needs of the patient.

      Posted by Jack on 1/17/2016 10:44 PM

    • Left RehabCare for this reason too. I did report it to the Attorney Generals office. So blessed to see justice served. I love being a therapist and helping people but I refuse to Rob them.

      Posted by Ex Program Director on 1/19/2016 11:15 PM

    • Bravo to all for speaking up and demonstrating support for doing so! It makes me proud to be a part of our profession!

      Posted by Lise McCarthy on 1/21/2016 2:28 PM

    • This is a wide spread epidemic amongst SNFs and the contract agencies that provide services for them. They involve therapists too much into the RUG levels and financials of the reimbursement system when the therapist should have NOTHING to do with those things. The treating therapist ideally should focus on the clinical picture of his/her patients and provide solid therapy service that is client orientated and not influenced by reimbursement eligibility. I've also seen clients needing therapy either passed by or given lower minutes because they had either no payer source or a minimal payer source. The therapists also need protection from those companies and SNFs that pervert our profession and prostitute our skills in order to fill their greedy pockets. Many therapists are the primary bread winners in their families and many are rightfully afraid to stand up for what's right because at the end of the day they need to put food on the tables for their families. At the end of the day the buck NEEDS to stop with the therapist and the only way I see therapists taking back the power that should be wielded by our training and knowledge is by an effective Union. This needs to happen. I'd be happy to start one if anyone is interested. Let's take back our profession from those that know absolutely nothing about what it takes to be a therapist.

      Posted by Brian Michaels on 1/21/2016 5:04 PM

    • Coming out of school, this was my first job. My DOR had the mindset like this and I will admit I was hesitant why I kept having to reevaluate long term residents when they were unskillable. I wouldn't pick up the people but I got wise to realize what was occurring quickly. I transfered to another site in RehabCare without any dilemma like I had at my original site. I'm rather glad this company has been reported. I love my career but by no means I am willing to lose it for this company.

      Posted by jiminy cricket on 1/21/2016 9:01 PM

    • Like the poster above me, I too worked at a SNF as my first job put of school. I experienced the same unethical behaviors and quickly left when the DOR tried to force me to pick up unskilled LTC unskillable patients just to keep caseload high. Not to mention, being forced to keep patients at a certain RUG level for max profit. I refuse to work in another SNF due to the highly unethical practices. More therapists need to become whistleblowers and not worry about their career being ruined for doing the right thing.

      Posted by East Coast Therapist on 1/26/2016 10:25 PM

    • I have been working in SNFs operated by three different corporations for the past three years. Strictly working part-time on a PRN basis, my experience with the scheduling, billing, and administrative practices in the various facilities mirrors some of the situations described in the comments about the topic. However, the degree of similarity is not indicative of an industry-wide commonality for all of the fraudulent practices described. No doubt, the SNF industry has put in place egregious methods of billing the highest rehab fees allowable under the myriad of rules put in place by Medicare and insurance companies. When fraudulent billing occurs, certainly such purposeful intent should be reported. I congratulate those professionals who pursue such illegalities with courage and resolve, putting their job security on the line. But, I am sure there are those amongst us working in SNFs that do not commit wholesale fraud to the extent noted in the case, nor are all of us subject to the degree pressures repeatedly mentioned in the comments. That is to say that virtually all corporate SNFs certainly do push the edge of the envelope when squeezing the maximum reimbursement possible is the primary goal. Working as I do a limited schedule by choice, I am not subjected to ridiculous production expectations at the facilities where I work. I do discuss the variety of comments my fellow professionals talk about regularly and I know full well there is some dissatisfaction with procedures etc. But, the example of Rehabcare is not a universal depiction for every SNF. Stating that, the industry has to make reforms, changes, and promote an entirely new relationship with the rehab professionals -or such new directions and procedures will eventually be forced the government. Of course, the current problems we all face in every venue of rehabilitative practice are, for the most part due to the gradual, insidious, and obvious degrading of our professional judgement and valuation by the governmental and insurance number crunchers. The APTA must be more forceful in openly discussing these ongoing problems depicted in the case. I feel our association has been lax regarding support of the members fora variety of difficult issues- present and past.

      Posted by Herschel Budlow P.T. on 1/30/2016 9:03 PM

    • I really feel like the Medicare bundle system will really help once Inforced. I really like the system, cuts down days and forces you to provide quality service. I've really enjoyed it with the TKA and THA billed drg codes.

      Posted by Kade Harris on 2/15/2016 7:06 PM

    • I really feel as if the the Medicare bundle system trails will be a better system. It cuts days really enforcing quality!!! I really enjoy it so far. Communication is great followed by a 20% savings in Medicare cost.

      Posted by Kade Harris on 2/15/2016 7:41 PM

    • OUTPATIENT PT also has a history of fraud as does Home Health. Look it up. IT"S NOT JUST SNFs. There have been numerous lawsuits over up charging, overbilling, and billing for services not rendered. I personally think most OP PT services are overutilized. The PT profession (OT & SLP too) needs to take a good look at itself and I agree, ethics needs to be stressed more. PT more so because they are so concerned about the move to DPT than they are about serious issues. One of the reasons I'm wanting to leave the profession.

      Posted by Anonymous PT on 3/1/2016 8:24 PM

    • I have been a Cota for 17 years and have seen so much fraud. It's getting worse. Ultra High category for all patients with skilled reimbursement rates! Medicaid patients are lucky to get 20 minutes. The SNF's are telling therapists how long patients will receive treatment regardless of progress or lack of! So tired of it! Certainly not why I got into this business!

      Posted by Theresa on 3/17/2016 9:42 PM

    • Unfortunatley, with most SNF's, this is how it works. The corporate level people with little history of working with pts hands on, are just looking at the numbers and how they look on paper. The more they treat at Ultra HIGH (720 minutes a week) the more money they make. I have thought about calling in for fraud . . . . but am afraid of repercutions against my job or license.

      Posted by No Name on 3/30/2016 10:33 AM

    • I work with a completely different population now and will not work for an agency that coerces its employees to commit fraud. It is my experience that all these agencies that contract with SNFs do the same thing (put patients in ultra high categories as much as possible, tell you to bill for an eval and treatment in the same day and use the treatment time to write up your eval, pull in as many disciplines as possible, etc).

      Posted by Speech Therapist on 4/5/2016 11:03 AM

    • In answer to the question "How could a therapist do this?" Not everyone does. And those of us who don't, don't work. Peer pressure therapist-to-therapist Is bad. I had a very young physical therapy director who got $$$ kickbacks based on how much the dept billed (Rehabcare). She rode me constantly, even writing up a very inappropriate employee review (I was a contractor, made no sense) stating that I didn't "treat as many cognitive patients as other speech therapists she known." I'll bet. She also tried to dictate how many minutes of therapy I would provide, but I told her that clinical decisions for mine to make. I was not popular and they couldn't wait to replace me. If everyone had banded together in the beginning and said we are not going to do this, it would have not of become an epidemic. By the same token, the employer has all the power and holds the employees economic hostage by threatening their jobs if they don't comply. Therapists spend a lot of money getting an education and often have exorbitant student loan debt so being unemployed Is horrifying. Further, it's hard to transition to another field because people see a very specific degree and don't want to hire us thinking will leave when the first good therapy job comes along. Most jobs don't pay as well as therapy so it's a legitimate concern on their part. Employers also bring in green card employees who often don't understand the system Or will do whatever they're told to do to protect their green card. I have been under employed for as long as I can remember because I refuse to play the game. I have had my productivity posted in and publicly shamed by administrators and directors alike. I have been told I am not "professional" because I won't adjust my minutes to achieve a higher RUG score or continue to treat patients who no longer need it in order to achieve a higher RUG score. Therapists do this to each other, because everyone is scared about being unemployed, and for some it's purely based on greed because they get incentives to do it and they clearly are not ethical. Ultimately, the therapist pays the price for inflated billing because administrators and rehab consultants don't sign the billing, we do. We have to say that it's true and correct. If a therapist is challenged about their billing and there is any punishment for upcoding or fraud, the administrator & director pressure therapist to do it in the first place always get away scot-free and point the finger at the therapist and blame them for doing it. There right, but they're also liars. I've sat on meetings with administrators who screamed at the staff and threatened to replace us with a contract company who will absolutely bill at the highest possible level all day long (that's what Rehabcare is). There's also no truth in documentation. Nursing homes lie, they teach each other how to cover up incidents, and bully employees who tell the truth when they document incidents. They remove documentation. State health department overlooks issues like low staffing patterns which lead to poor care because there are no standards. Your best bet is to understand what your diagnoses or the diagnoses of your loved ones are, and to demand the most appropriate level of treatment. And if at all possible, stay out of nursing homes. It is the worst possible care at the highest possible rate with people who are more interested in how much money they can make off with you than whether or not you actually get better. Most facilities warehouse patients even hold them hostage, refusing to discharge them until they'r even hold them hostage, refusing to discharge them until their insurance has completely been exhausted. Then they put the boot in the back of their insurance is exhausted. And then they get the boot to the backside or a very big bill to pay.

      Posted by Sue on 4/9/2016 9:13 PM

    • Hope the mgmt at Md - based FC read this article

      Posted by PT extrodinaire on 4/15/2016 11:53 PM

    • You can tell exactly who the rehab managers on here are. They make excuses for their practices. Divide up the treatment, you say? Then you're on our cases because of efficiency demands. You're all a bunch of hypocrites in middle management.

      Posted by Philip on 5/18/2016 6:37 PM

    • It's great to know more of these cases are being brought to light so that improved ethical practices will hopefully result. I have worked in SNF's for about 15 years. I have seen the good and the bad. Despite what you may see on list serves, there are still goo places out there. While I believe it's wrong to push a therapist to perform services not clinically necessary we do have to step back at some point and take a look at the big picture. Therapy professionals have responsibility in creating this problem. I have seen many therapists engage in practices to boost productivity or numbers and this makes it difficulty for the facility down the street trying to do it right. I even saw an in-house company who did quality therapy, no productivity standard and clinically supported levels ushered out the door and replaced with a big therapy contract company that promised the world. The SAME therapists were 90% productive and doing therapy on patients they wouldn't before within a couple weeks of takeover. But each of them were so happy with their big raises...they didn't seem to care.

      Posted by withheld due to employment reasons on 5/30/2016 9:11 AM

    • Having previously worked as a traveler in many different SNF's I can say that all of the above is true in terms of actual practices in these SNF's and certainly with RehabCare/Kindred. I do think that a big part of the problem is that the reimbursement system itself is flawed. I don't have a good solution and pressuring staff to provide unnecessary services is definitely unethical, however I do feel in a system where 1 unbilled minute can result in hundreds of dollars loss because of a missed RUG level that the billing system itself is flawed and it fuels fraudulent practice.

      Posted by BostonPT on 6/2/2016 4:41 PM

    • I am so glad to here this news.I have been a clinician for 17 years in the NY/NJ area. I have worked primarily in nj the last 11 years. I have worked for several companies and it is absolutely no difference in their expectations. I've had to move around from different companies due to the fact that I stand my ground ethically speaking. It has hurt me from a economic stand point. I would love to do home care but, we as cota's are not allowed at this time. The state of nj has opened more cota schools and this is who the companies are hiring at this time. I speak with colleagues but, money drives the ship. We are all frustrated but, there are too many therapist that accept the conditions as such. I hope for the sake of the patients that therapist stand up and realize that we have more power as a group. However, yes the system is flawed and there are changes that need to be made sooner than later. I just implore the DOJ to keep looking because there are more unethical companies out there especially in the state of nj.

      Posted by jERSEY COTA on 6/13/2016 11:09 AM

    • Medicare needs to change how they reimburse NHs all together. I've been a therapist for 12 years working in SNFs and I do not know a single company who does not do these same unethical practices. It's not just the rehab companies. It's the companies that contract them out as well.

      Posted by Reyna Carson on 7/30/2016 11:40 PM

    • Right on to the poster that commented that you can tell who the managers are in the posts. We all know that just because a SNF patient is at the facility that doesn't necessarily mean they are there appropriately. Evidence based PT certainly has its flaws. We need to stop allowing ourselves to be exploited. Stop tho nonsense

      Posted by LJ on 10/29/2016 4:30 PM

    • Good job Janet Mahoney it is very true Rehabcare will actually threaten therapist to be send home if no enough caseload so they will force therapist to screen and pick up even inappropriate patients as long as the have coverage...

      Posted by john dillinger on 11/1/2016 11:00 PM

    • I wish that the productivity for therapists were made illegal or limited within 80-85% and only then the clinicians could provide quality care and quality documentation. Employers would still earn a lot of money. I also feel that a single company in healthcare should not be allowed to provide in thousand different locations. In my experience, I see that in-house therapy companies were doing great but somehow got worried about electronic documentation and were tricked into or lured into having Contract companies.Since it is a big money making game, contract companies got too greedy.

      Posted by MD Khan on 11/18/2016 7:57 PM

    • THe amount of pressure that is put on us but these rehab companies is too much. It is difficult to manage the extensive paperwork and pt care in 8 hours. How could anyone possible have a chance of doing at good job? These productivity rules are horrendous. The only way this industry is going to change is if we stand in unison. Our associations won't stand up for us...therefore, i won't become a member.

      Posted by no name on 11/27/2016 8:56 PM

    • I just saw these helpful posts and I am sooo relieved not to be the only one bothered by "getting your minutes" and quotas on length of stay. Productivity standards are counterproductive and jeapordize good patient care. I wonder if managers realize how demoralizing working in SNF's has become. I used to love it and feel very sad for our "greatest generation" of elders who deserve the best healthcare. Please let's keep the discussion going. I need my job too much to give my name right now. I can do something brave to advocate for the frail elderly if you can all lend ethical support. Thank you Janet Mahoney Shawn Fahey and all who have courage to come forth.

      Posted by Conscientious SNF therapist on 1/23/2017 8:44 AM

    • WOW!!! I am so glad to know I am not the only one who feels trapped by the system. There are not enough jobs for OTs/COTAs to switch to that are outside of contract companies. I wish there were more investigations going on and that the government would take notice and help make our field of work reputable and respectable again.

      Posted by anonymous on 2/1/2017 10:17 PM

    • As the government squeezes, the pressure goes up for therapist's. Nothing will change, sorry to say, from the lawsuit. All that happens is more pressure on therapist's to do the impossible. When the company looses money, our benefits get cut, PTO cut, wages freeze...That is why I am going PRN, as an OT/PT (not saying which), willing to take a paycut and stick with evaluations mainly with PRN work. This will never change as long as therapist's work in SNF's. If we all try to get out as much as possible - maybe the ball will be in our court for a change and we can do what is most appropriate. We all need to start making sacrifices if we truly want this to change.

      Posted by anonymous on 2/1/2017 10:28 PM

    • I worked for a kindred building and comparing them to other places They have the best care for patient and employees , if i call the nurses about a patient needing stat care all nurses in that unit will run and address the issue.the foverment need to focus on basic care given due to work ethics changing in the SNF . Per therapy issue everybody is to blame on how the system went down. There is no one department in particular because the rules and regulations now is choking whatever passion we have for our chosen profession. As i always say ,not one diagnosis is the same and not one patient will respond to a treatment the same. You can never put human lives as BLACK or WHITE. With the push for shorter treatment program and us predicting our patient response irregardless of the co morbidities these people have INSURANCE is driving the treatment that we can provide. What i felt bad about is the patient being sent home because insurance stop paying even if they don't have anybody at home to take care of them.Let us do Our JOB and let us HELP our patient irregardless of payor source. As a foreigned train therapist from the moment i step in this country all i know is , if we don't follow the rules we go to jail. Thats a constant pressure we have to have in mind everyday that we see patients but we have regulations after regulations that no matter what you do your always on the edge. You will never be complemented when you change somebody's life because you make them better. What they worry about is how we document and not the way we treated our patient. We are not magicians and i don't have a crystal ball to predict what will happen to my patient , I am just a mere Therapist that wants to do the best i could for the patients and life that was entrusted to me.

      Posted by Anonymous on 3/15/2017 10:11 AM

    • Are you willing to take significant pay cut and reduced benefits? I don't think so! Are you willing to provide treatments on your own time? You cannot have a cake and eat it too! Wait till you are 95 years old and have the therapist not give you a fair share of your entitlements and a fair chance of recovery! You need to look at the problem from the other side as well! it is easy to talk big!

      Posted by anonymous on 4/12/2017 5:57 PM

    • Sadly, Rehabcare settled for justice but Select Rehab has grown big now and they are doing it boundless. Co-treating all patients but charging separately. PTAs have to be 95% productive and PTs 92% on a daily basis. Everyday, the manager will hunt you down and ask why productivity was below 90% even when you have 20-25 Progress notes to review as a PT. I should mention Encore here too. Their quality analysis wanted me to co-sign progress notes for the dates I was not even in the country! Genesis just raised the PT productivity standard to 92%. My good colleague resigned! I met an senior citizen who wanted to know my profession. When I told him, he was quiet for a moment and he said that his niece work 70 hours but gets paid only for 40 hours because she punches out early to show productiveness and keep her job. It is a shame that APTA emphasized PT Standard so highly but never stopped all these corporate greed. All the good and small companies are bought out by these big companies and now they the clinicians are at their mercy. They have to chose from the lesser of two evils!

      Posted by Caring for patients on 9/7/2017 7:25 PM

    • I want to be a whistleblower!!! help me

      Posted by Tracey Sweet on 2/3/2018 7:44 PM

    • We have chosen our professions and worked in various settings for one primary reason- we enjoy working with people and want them to get better. Ten years ago I singed on with a brand new company. The reason we were told the company was started? Their motto was and is Excellence in Performance. The reason was so the founder could make her first million! Check out the motto.

      Posted by Lorraine on 2/4/2018 6:15 PM

    • I was retaliated against when I went to my company's corporate compliance and told them to investigate people working off the clock in order to meet the productivity standards. They replied to me and said it was rampant throughout the apartment on a Monday and we're going to talk with the director on Wednesday. On Tuesday of that week she sent out an email reminding everybody that we want to pay you for the work you're doing so if you're caught working off-the-clock there could be disciplinary actions. When they brought the findings to her on Wednesday she pointed at the email she had sent the day before and said what a coincidence. I was then put on an action plan and falsely written up and forced out of the workplace that I loved due to this directors in confidence and focus on productivity. I have contacted the OIG and other departments about fraud waste and abuse but I just got a letter in the mail that says they'll keep it on file and if they continue to get more of them then they'll investigate. I now work for Rehab Care and they continue to do the same thing, they want you to be 85% productive and they do that by only giving you one unit for an evaluation so therapist do an evaluation for 10 minutes then charge something like gait or ther act even though those should just be part of the initial evaluation. It's dirty..... but i know first hand fighting the system gets you a target on the back. I would rather not work then work unethically so I'm just flying below the radar until someone sits me down and questions my low productivity but it is what it is... I will not bill unethically.

      Posted by John on 3/5/2018 11:01 PM

    • I have been an SLP for 14 years. For the first 12 years of my career, I worked for a privately owned SNF in which there was no productivity and our average stay was 17 days or whatever the patient actually needed. Our focus was PATIENT CARE!!!!! Our DOR did not set RUG levels until after 1 week to determine exactly what the patient could tolerate, when, corporate healthcare bought them out and Empres Healthcare took over. I have now traveled for 2 years, all companies set all residents at ultra highs, I have been asked to go back and add minutes to sessions from previous days which I called the building out for fraud, I have worked in building that use the patient's 100 days regardless and then immediately turn around and start them on Med B, I have been threatened, I have been told that if I don't meet 85% productivity that I am not allowed to work over 30 hours, hospitals tell patients and their families that they have 100 days no matter what. I am very supportive and we need COTA's and PTA's but all these companies have them as the DOR, and when you have an assistant trying to tell you how/when to eval and discharge(because they are being pressured), I want to lose my mind!!!!!.....Fraud and bullying are rampant and all I can think of is that I love what I do but I am desperately trying to get out of healthcare!

      Posted by Bree E Weinstein on 5/17/2018 10:24 PM

    • It does not matter what discipline your rehab director is, assistant, doctorate level, Masters level, or otherwise. A business person is a business person running the show. Management is management. Making a buck is making a book. It is wrong to commit fraud. These skilled nursing facilities must learn how to work within their budgets just like the hospitals have just like grocery stores have just like the babysitter has. Just like all of us have. As additional insurance reimbursements shrink, and they will, these companies and corporations need to strategically figure out where they need to shave the fat so to speak. Maybe less office supplies, maybe nobody gets a Christmas bonus or any bonus including corporate and management, maybe no more fancy luncheons in the board room, maybe start charging the families Or resident for the cable TV. I don’t know the answer, but the current system of management is not working. I will not work and I Nother nursing home situation ever again. In fact I’m getting to the point where I’m aging out of the physical therapy world. It’s fine by me. This is not what I got into physical therapy for all those years ago. When I hear our young people today Saying they want to go into healthcare I advise them to go into computers

      Posted by Anonymous on 6/26/2018 8:22 PM

    • I first noted these practices by rehab management companies, as an SLP, just after grad school, while working in Florida. This was pre-RUGS, PPS, high, ultra high billing status pressures. However, in those days, rehab companies were making around 50 bucks a unit, and no ethical self regulation was mandated. DORs would entice rehab professional staff with incentives like anything billed over 32 units a day (over 8 hours right?), the therapist would get a kick back ("an earned bonus"), of say 10 dollars a unit. This was an open and shameless practice. Unbelievable? No, it occured routinely. I mentioned it with other staff, and heard things like "Just go along with it;" or You're a trouble maker." I always revolted, and rebelled, and now more than ever the issue in SNF settings has been an incredible outrage. I had a long hiatus from travel and contract therapy staffing companies who contracted with therapy management companies in SNFs (e.g., RehabCare), until 2010. This was after PPS, RUGS, untrahigh--placing patients in the highest-possible reimbursement levels, regardless of determinations made through patient evaluation. I resigned a number of jobs because of it, which has not helped my carrer. When I now hear about, or have been pressured with 90-95 % productivity, I know that is ridiculous, insane, and blatantly fraudulent...90% plus it is not possible. There is no truthful way to rationalize that, period. I especially resent it when it comes from a PTA, or COTA manager, to an experienced veteran SLP with dual master's degrees, who entered the profession to serve humanity. As professionals we need to take back any modicum of ethical standards left, and be bold and fearless about re-establishing clinical independance for decision making, and report these fraudulent practices, holding corporate greed to the fire continuously; tell them, "I believe that to be a fraudulent practice." They won't hire you, won't even speak to you, may even attack you in some fasion. Remember, they pressure us as SLPs, PTs, OTRs to perfom these practices, and it is we who comply and carry them out. We have to start somewhere. The above precedent is encouraging.

      Posted by Shamus on 7/13/2018 1:38 PM

    • Doesn’t this happen at every SNF? Yes, it does. To some degree or another it happens at every SNF, I guarantee it.

      Posted by Derek on 11/29/2018 2:28 PM

    • I have been expressing my concerns as well for last year or so; now all of a sudden I was written up! Totally retaliatory! I desperately need out of healthcare!!!! Any ideas anyone?

      Posted by TryinToBeAPatientFirstTherapist on 12/1/2018 2:00 PM

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