Let's Help Each Other

Physical therapy is changing rapidly. As a PT with more than thirty years of experience, the changes observed in the last ten years triple those of the first twenty years. The pace of change is not slowing down. The Medigraph Blog will serve as a forum that will enable us to exchange ideas and assist each other. This blog will be used to share billing, documentation, and any other ideas to improve any aspects of our profession. If we share what we have learned, we can develop a resource that enables our collective understanding to advance our careers.

As profit margins grow smaller and expenses grow larger, we need to assist each other to survive and prosper. If we share our experiences we can help each other to grow professionally, administratively, and financially. Our professional lives, our livelihood, and our personal lives are intertwined. Our resources individually are limited. Together we can accomplish more than we can individually. Let's help each other

Regards,

Tom Kane, PT
MediGraph Software

Medicare Anti-Fraud Act Denies Medicare Providers Future Access
8/19/2011 4:10:00 PM
A recent bill introduced to Congress under the name of the "Strengthening Medicare Anti-Fraud Measures Act of 2011 (the "Act"), increases DHHS'' existing powers.  (Reminder;  coding errors can be treated the same as fraud).   Instead of paying a fine (prior restitution for fraud), the bill allows DHHS to exclude owners, officers, and mangers of companies that are convicted of health care fraud from participating in federal healthcare programs.  According to the DOJ (Department of Justice) and HHS, new aggressive initiatives to combat health care fraud also allows for the criminal prosecution of owners and executives.  According to the Act, the exclusion and/or prosecution may proceed even if the owners and executives were not complicit in the fraud, but could have stopped the fraud if they had known that fraud was occurring.   Stated more colloquially, if you did not know that fraud was occurring, but you were in a position to stop the fraud if you did know, you will be prosecuted as though you committed the fraud.  To avoid criminal prosecution (and the legal costs to defend yourself),  you could just surrender your ability to accept Federal insurance, and agree not to work in a facility that accepts federal insurance. (Where could you work?). You may be thinking, "Are we talking about the USA?"  Sadly,  our run amok government considers us criminals even if we did not commit the fraud, but would have prevented the fraud if we did know about it.  (Sounds like ''''Minority Report'''' starring Tom Cruise!).  Therefore, if your billing clerk or agency submits an improper code by mistake (and this code is repeated multiple times), you committed Medicare Fraud.  If your documentation clearly identifies the content and context of your treatment, your documentation may serve as mitigating factors that weigh in your favor.  However, improper documentation could be used against you to substantiate the fraudulent intent (though none existed).  Please understand that having proper documentation is not a guarantee that your error will be dismissed.  But having improper documentation almost guaranties that you will be prey for a government bureaucrat that understands you can be excluded from all Federal healthcare programs or undergo prosecution.   As mentioned previously on this blog, CMS has re-characterized physical therapists in the Moderate risk category for fraud.   Has fraud occurred?  Yes it has.  Are the vast majority of our colleagues honest?  Yes they are.  These overreaching rules and classification of PT in the Moderate fraud risk categories should serve as a warning. Everyone is vulnerable.   
 
Be well,
Tom Kane, PT
MediGraph Software