I recently received an e-mail notification of an upcoming ethics course. It was titled "Red Lobster, With a Side of Ethics". Since my PTA license is soon up for renewal, the timing was perfect. Texas requires all licensees to attend a two-hour of ethic course for PT/PTA license renewal.
Not a single PT or PTA I know gets excited about attending a mandatory ethics course. It's just not that exciting. Ooooooh... but an ethics course at Red Lobster...? Now there's something I can get (a little) excited about. Plus the course was being presented by three friends/PT colleagues of mine. So thanks to Dee, Christina, and Jon for providing an INTERESTING ethics course. The appetizers weren't too bad either!
It was ironic that less than two weeks later I came across a stunning report that appeared on CBS This Morning. The report, "Medicare fraud allegations: National nursing home chain accused of billing for excess care" covers current Medicare/OIG investigation of Life Care Centers of America for providing excessive therapy services to patients in order to receive a higher level of Medicare reimbursement in the skilled nursing setting.
According to the report:
"Medicare reimbursed $4.2 billion to Life Care Centers between 2006 - 2011. While skilled nursing facilities averaged 35% of treatments for rehab patients at the ultra-high level nationwide in 2008, Life Care Centers had 68% of therapies at the ultra-high level, court records say. Rehab therapy claims have come under increased scrutiny in recent years, with other nursing home chains also have faced accusations of upcoding."
I'm curious to know how many of you are honestly surprised about the current investigation into Life Care Centers, and the LTC industry in general. Of course Life Care strongly disputes any wrongdoing. Which begs several questions: How much therapy is too much therapy? And who is really responsible? Is it the evil corporation? The CEO? The Regional Director? The facility Director of Rehab? The staff therapist?
Probably all parties are culpable, but without a doubt, the licensed therapists are! (These people must not have mandatory ethics courses.)
The alleged widespread over-utilization issue presents a bit of a stumbling block for a profession that is trying to "Move Forward". It is the elephant in the room. Until now I haven't heard much about over-utilization in the news, but more surprisingly, I've never heard it discussed in our state or national professional association meetings. This could be a significant setback for those who are striving to elevate the profession by working to enhance access to physical therapy services. It wouldn't surprise me if over-utilization will be used to legislatively by direct access opponents.
Kudos to the whistle blower(s) who made an ETHICAL decision to do the right thing. Hopefully this case will draw enough attention to the issue that therapists AND corporations will become more ethical and conscientious.
Great article. I look forward to more! I'm a recent grad going into a SNF, so I'd love to read anything about that setting and/or ethics related to it as well!
ReplyDeleteYou know I was just talking about this at work the other day and it amazes me that there are so many PT's/PTA's out there that would compromise their own ethics and break the law just to make a lot of money. It's not limited to LTC facilities either...I've heard of it in OP facilities and HH companies as well. Unfortunately you're right about it being a stumbling block...it's become harder and harder to justify and receive adequate outpatient visits for the patients who really need it because of the abuse of the system. Everyone suffers, not just those who are committing the abuses and often it's the patient who ends up with the short end of the stick.
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