Shamelessly invoice at your own risk

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John O'Connor
John O'Connor
Here's the good news for providers: new analytics are making it possible to understand and bill your care in ways that would have been impossible just a few years ago. Here's the bad news: The government is quite aware of these new options.

If there is one message operators should take from the McKnight's Online Expo webinar Leah Klusch presented Wednesday, it's this: Don't cheat. That may be a harsh way to describe creative invoicing. But “Don't Cheat” should be posted on the cover of every billing manual on your property.

To put Leah's advice another way: Make darn sure you document everything you claim to be doing. For if there is one thing auditors are getting better at, it's smelling manure. At the very least, your math had better add up. Moreover, it had better make sense. For example, end-stage Alzheimer's patients are probably not going to hold up well to 12 hours of intense physical rehab every day, no matter what the billings might suggest.

As Leah pointed out, RAC audits are turning out very well — for federal auditors. It seems their bean counters can understand metrics, analytics and creative bookkeeping just as well as hired guns and creative bookkeepers in the private sector.

Think your therapy partner or an outside vendor will take the hit if things get ugly? Think again.

Earlier this week, a federal judge ruled that a False Claims Act lawsuit involving a nursing home chain and therapy providers in Missouri could move forward. The case originated when a whistleblower alleged that a therapy company received more than $10 million in kickbacks as part of a scheme to overbill Medicare and Medicaid.

The complaint involves James Lincoln, who owned nursing home company Health Systems Inc. and therapy company Rehab Systems of Missouri. Rehab Systems provided therapy at the 62 Health Systems facilities. Lincoln allegedly entered into an illegal subcontract agreement with another therapy company, RehabCare, in 2006.

As McKnight's reported, RehabCare allegedly took over therapy at the Missouri nursing homes with the understanding it would increase Medicare and Medicaid billing. RehabCare paid Lincoln's Rehab Systems $600,000 to take over the therapy, and reportedly promised to pay Rehab Systems 10% of its ongoing billings. Federal prosecutors say Rehab Systems received more than $10 million through this deal, even though the company essentially ceased to exist after 2006.

The scary part here is not that this story broke. What's truly frightening is how many more stories like this might be out there.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.