Homecare and Therapy Services Can Land You in Jail!

Homecare and outpatient physical/occupational therapy continue to be under scrutiny by the Federal Government.  These areas of healthcare are easy to commit fraud.  Recently, in Detroit, several defendants were convicted of healthcare fraud and sentenced to prison.  The defendants:

“recruited and paid cash kickbacks and other inducements to Medicare beneficiaries in exchange for the beneficiaries’ Medicare numbers and signatures on documents falsely indicating that they had visited Patient Choice and All American for the purpose of receiving physical or occupational therapy.  [Defendant] admitted that a large number of the beneficiaries were neither homebound nor in need of any physical therapy services.

[He] also secured physician referrals for medically unnecessary home health services through the payment of kickbacks to physicians or individuals associated with physicians.  He employed several physical therapists and physical therapy assistants to sign medical documentation needed to begin billing for home health care services, including initial payments and payments for each visit to a Medicare beneficiary.  [He] acknowledged that he knew the physical therapists and physical therapy assistants were not actually conducting a large majority of the visits or treating a large majority of the patients, and confessed to billing and receiving payment from Medicare for services not rendered or medically unnecessary services.

Between approximately August 2007 and October 2009, [defendants] at Patient Choice and All American submitted approximately $10.8 million in claims to the Medicare program for physical and occupational therapy services that were never rendered or were medically unnecessary.”

Department of Justice, September 12, 2013

If homecare and physical therapy services are your specialty, how do you prevent the government of accusing you of fraud?  The first and most important protection is your documentation on your homecare visit.  “If it’s not in the chart, it didn’t happen.”  No matter how busy you and your staff are, you must document.  Also, all of your homecare plans of care and authorizations must be up to date.  Getting behind in your documentation is impossible to explain.

Next, your staff should be educating patients and referral sources on the rules for homecare and therapy visits.  We often hear that doctor  feel they must offer “perks” since their competitors are offering similar bonuses.  This is never a good idea.  Remind your referral source that any “perks” they accept will cause scrutiny to their practice as well as yours.  “ignorance of the law is no excuse.”

How do you keep up with your documentation?  Share your ideas with us by clicking on the comment button below.  We’d love to hear from you.

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