You might notice a common theme with this week's links - fraud.  Whether it's Medicare Fraud, Medicaid Fraud, or Exploitation of the Elderly, it's everywhere.  Whatever happened to honesty and helping people?

One of the links refers to "over payments" one company billed over the past year to Medicare - $35 MILLION DOLLARS in over payments.  Many Nursing Homes don't employ their own therapists, they contract with professional rehabilitation companies, which is the business model for RehabCare. Since Medicare pays close to $1,000 per day for a senior to receive the maximum amount of therapy possible for a nursing home patient, is the goal to perform as much therapy as possible or to help as many patients as possible?  

I've been present when patients are goaded into receiving more therapy, being forced to stay longer in a nursing home than they wanted to, simply because the patient had "days" left (Medicare pays up to 100 days in a skilled nursing facility).  If a patient has payment left, they'll receive rehabilitation whether or not they want it (and even be threatened with a report to Elder Protective Services if they want to leave before the nursing home wants them to.   But if the patient is out of "days," the nursing home will dump them out as fast as they can.  I've also seen more than my share of dying patients being forced into therapy because Medicare doesn't pay for a patient to die in a nursing home, only to receive physical therapy.

The amount of therapy provided to a patient is at the sole discretion of the rehab company; the more minutes billed, the more Medicare pays.  The system is flawed, because the chances of Medicare identifying fraudulent billing practices are pretty slim - and $35 million dollars is a drop in the bucket compared to the hundreds of millions of dollars that Medicare pays for therapy.  It's better to keep on keeping on the way they have been.  

I've seen a lot of rehab in my day, and whether it's under the Part A or Part B programs, Medicare is paying a shitload of money for therapies that often don't make a bit of difference to the patients.  Rehabilitation can be helpful, but when a company can repay $35 mill and not bat an eye, there's something wrong.  
 


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