The US Department of Justice announced this month the indictment of yet another sham therapy operator in Detroit. According to the DOJ Press Release
Evidence at trial established that Bernice Brown was the owner and president of Wayne County Therapeutic Inc. (WCT) in Livonia, Mich. Daniel Smorynski was the vice president of WCT. WCT purported to be an outpatient clinic that specialized in physical and occupational therapy. Evidence at trial established that Brown purchased fake physical and occupational therapy files from certain third-party contractors, and she and Smorynski billed the services reflected in the files to Medicare as if WCT therapists had provided the services. Brown instructed her staff to create false documents and to add those documents to medical files to make it appear that the WCT therapists, who were licensed in the state and enrolled with Medicare, had performed the services, when she knew they had not. According to evidence presented at trial, Smorynski was in charge of billing at WCT and aided in the submission of claims for services he knew WCT did not provide. Between approximately October 2002 and September 2006, Brown and Smorynski submitted approximately $23.2 million in claims to Medicare for physical and occupational therapy services that were never provided. Medicare paid approximately $6,537,630.34 of those claims.
The ink has barely dried on the last summers round of sham therapy operator indictments as this was announced. Detroit is one of the Medicare Strike Force cities where the DOJ and other federal and state authorities have teamed to stop fraudulent Medicare billing activities. Also referenced in this indictment is the fact that the therapists were often not enrolled in the Medicare program and/or were not properly licensed to practice. As with other schemes of this type Medicare beneficiaries were “paid” a kickback fee for the use of their Medicare number, and therapy orders from physicians were fake.
Posted in Compliance Therapy Fraud by .
The Medicare Payment Advisory Commission (MedPAC) relased their June report to Congress last week. Of note to the rehab and therapy community is Chapter Eight: “Addressing the Growth of Ancillary Services in Physician Offices.”
The chapter on ancillary services addresses outpatient therapy including physical, occupational and speech therapies. Of note is the discussion regarding the growth of ancillary services which includes eliminating outpatient therapy from the in-office ancillary exception to the Stark regulations, noting that “incident to” services declined from 30 percent share to 16% share of spending for therapy services. Also discussed is limiting the exception to practices that are clinically integrated.
Posted in Private Practice by .
The HHS Office of the National Coordinator for Health Technology released the final rule today that includes provisions for temporary certification of programs for EHR. (This will eventually be replaced by a permanent certification program). The entire press release can be found at the HHS website.
“By purchasing certified EHR technology, hospitals and eligible professionals and hospitals will be able to make EHR purchasing decisions knowing that the technology will allow them to become meaningful users of electronic health records, qualify for the payment incentives, and begin to use EHRs in a way that will improve quality and efficiency in our health care system,” said David Blumenthal, M.D., M.P.P., national coordinator for health information technology. “We hope that all HIT stakeholders view this rule as the federal government’s commitment to reduce uncertainty in the health IT marketplace and advance the successful implementation of EHR incentive programs.”
Posted in CORFs Private Practice Rehab Agency SLP in Private Practice by .
Lewis Morris, the Chief Counsel to the Office of the Inspector General (OIG) of HHS provided testimony this morning before the subcommittes on Health & Oversight of the U.S. House Ways and Means Committee. The text of Mr. Morris’s message provides insight into successful fraud and abuse intitatives by the OIG as well as the success of combined initiatives, as well as insight into future fraud efforts that have been enabled by the Patient Protection and Affordable Care Act (ACA).
In an excerpt from his prepared remarks Mr. Morris describes health care fraud:
Health care fraud schemes commonly include billing for services that were not provided or were not medically necessary, purposely billing for a higher level of service than what was provided, misreporting costs or other data to increase payments, paying kickbacks, and/or stealing providers’ or beneficiaries’ identities. The perpetrators of these schemes range from street criminals, who believe it is safer and more profitable to steal from Medicare than trafficking in illegal drugs, to Fortune 500 companies that pay kickbacks to physicians in return for referrals.
Posted in Compliance OIG by .
In a recent RACMonitor.com article on The Curious Case of the CORF the CORF was described as an “orphan” program that had conflicting regulatory advice for providers in recent years. The Conditions of Participation, the State Operations Manual Interpretive Guidelines, and various instructions from the Medicare Contractors (fiscal intermediaries and MACs) put the provider at a disadvantage. Many long-time rehab providers with Medicare certification as a CORF found that claims were being denied based upon the confusion between the requirement that the physician “wholly” develop the plan of care in a respiratory CORF and the requirement that the physician develop the plan of care in a physical therapy CORF. Implicit in the physical therapy CORF is that the physical therapist will provide input from the therapy evaluation to develop (or develop in concert with the physician) the CORF plan of care. What is different about the CORF is that that therapy cannot begin until the plan of care is certified, whereas in other outpatient rehab settings there is a timeframe of up to 30 days for the physician to certify the plan of care.