When LTC leaders delegate accountability

John O'Connor

Many good business books have been written about the importance of delegating authority. Rightfully so. For when the work of a manager exceeds her or his capacity, there needs to be a system in place for sharing the work. In businesses with as many moving pieces as nursing homes, delegation is essential.

But what happens when delegation without accountability takes place?

We saw a good example last week, when the Office of Inspector General released a damning report about excessive Medicare charges. The watchdog group reported that operators padded their Medicare bills to the tune of $1.5 billion in 2009. This was done largely by inflating expenses for speech therapy and occupational therapy that often went to patients who couldn't benefit from either. In one galling example, a patient under hospice care refused physical therapy but received it anyway, and Medicare was sent an invoice.

I am willing to bet that many of these charges were not filed by nursing homes, but instead by contracted rehab services providers. And by the way, let me hasten to add that contract therapy companies have been a godsend to the field. They deliver care that many facilities simply cannot or will not do.

The blame here must go to the managers who either failed to check billings before they went out, or simply didn't care so long as Medicare payments for rehab care remained on a nice, upward trajectory. As much as I love this field and respect the people who put in tireless effort to make life better for residents, we have a problem here.

At far too many facilities, administrators, directors of nursing and other leaders need to do a better job of ensuring good faith compliance with existing standards. That doesn't just mean making sure the documentation looks good enough for government work. It means being willing to testify in court that the work being billed for is being delivered as indicated, should it come to that.

These are fiscally challenging times. And I have no problem with facilities making a buck. But let's not forget where the buck stops. And if you think I'm out of line for pointing this out, imagine how bad you might feel later if auditors call with some uncomfortable billing questions?

If you have nothing to worry about, don't worry. But if you suspect there are billing irregularities in your facility, I'd recommend you act now to address the matter. The bottom line here is that you are in charge and accountable. Failing to do so could prove pretty expensive. That is, unless you don't mind losing your reputation, your job and perhaps your career.