DOJ the latest to pile on in therapy-billing mess

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James Berklan
James Berklan

Don't let anyone tell you that long-term care operators don't know how to read between the lines. They might not have known to fear a McKnight's Daily Update item before it appeared Sept. 8. But it quickly and definitely earned their attention — and apprehension.

 “Nursing homes must oversee their therapy providers,” the headline read, in part. While many might find that statement a bit obvious, others, including many providers, believe the story reveals unfairly assigned responsibility.

True, the $3.8 million settlement is merely a drop in the bucket compared to other gargantuan settlements in this sector. But the impact of this one could have ripple effects beyond estimation.

The Department of Justice announcement that spurred the news article could be a shot across providers' bow. Veteran observers feel other similar settlements could be on the way. Or possibly worse: criminal indictments.

Providers around the country have nervously taken notice. As regulatory and payment expert Leah Klusch noted: Just as an administrator must take ownership for his or her building's MDS assessments, so must Mr. or Ms. Administrator be on the hook for any malfeasance that stems from a contract therapy provider.

It might not be fair, but responsibility must be assigned and the guy with the biggest stick usually gets to determine who's responsible. 

While some commenters below the mcknights.com website story decried allegedly greedy contract therapy companies, others felt skilled nursing providers need to be more accountable.

It just goes to show that Uncle Sam is not ready for placement in a memory care unit yet. His recall is as strong as ever. Once providers were “busted” for collecting disproportionately high amounts of rehab funding after recalibration of the MDS form and RUGs a few years ago, it's been a rough ride. 

Trying to pocket billions of dollars the feds don't think you're entitled to tends to boost indignation. So much so that CMS announced after just six months under the new program that it would be nearly immediately snatching back $5 billion it believed providers wrongly collected.

There was no reading between the lines to get that message. Or this one: Officials are prepared to continue with more harsh lessons, especially for those they think still need them.


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