Physicians and physical therapists involved in Medicare fraud seem to invite similar negative results.
This recent (Dec. 22, 2010) Wall Street Journal article highlights the dangers of physician-owned physical therapy (POPTS) as well as outright fraud by self-employed physical therapists.
The WSJ article goes on to describe physicians in Miami and Houston billing for physical therapy services and a physical therapist in New York billing $2.5 million to Medicare in a single year.
Maybe we should separate physicians and physical therapists?
One solution is to outlaw physician ownership of entities to which they self-refer (eg: physical therapy, clinical laboratories, imaging centers, etc). This only seems reasonable to most people.
The situation in medicine and physical therapy is that 1% of the providers give the other 99% of us a bad name. The opposite situation exists in politics where 99% of the politicians give the rest of them a bad name:)
The Federal government figured out the self-referral situation in 1989 (Starke I) and extended the anti self-referral rule to Medicare in 1993.
But, concerns that government was intruding too far into medicine and legitimate business arrangements allowed doctors to apply "exceptions" for in-office physical therapy services in 2005.
This Rock-n-Roll doctor took $1.8 million in Medicare in 2008, much of it from physical therapy, shake-n-bake treatments he prescribed for his patients.
The treatments were not done by physical therapists but by "office girls" that he "trained" himself. Medicare caved-in to POPT physician pressure when they wrote Federal licensure requirements:
"Qualified personnel may or may not be licensed as therapists but meet all of the requirements for therapists with the exception of licensure."
However, Recovery Audit Contractors (RAC) audits of providers find that inpatient hopitals, not Nigerians or Rock-n-Roll Doctors, are the largest source of cash to the RAC revenue generation scheme.
Inpatient hospitals are likely targets, not because of outright fraud, but because the system is too complicated, medical billing too technical and billing errors the result of mistakes not crime.
Who commits most of the crime in Medicare fraud?
It's not providers. It's not even fancy rock-n-roll doctors.
60% of healthcare fraud is due to the pharmaceutical industry and insurance companies.
| Industry | Recovery(millions) | Per Cent |
|---|---|---|
| Healthcare Provider | $2,122.25 | 38.8% |
| Insurer | $890 | 16.3% |
| Pharmaceutical | $2,459.75 | 44.9% |
| Total | $5,472.00 | 100.0% |
My kids don't know when to separate themselves so I do it for them and we keep peace in the family. How can we keep "peace" in our adversarial Federal healthcare system?
If we can't separate physicians and physical therapists then what about removing the requirement for the physicians' signature on the physical therapists' Plan of Care?
Isn't that the source of the conflict?
