Think Compliance doesn't matter?

Then think again. 

Many in the PT industry are taking the news of Stryker Medical Corp’s former Physiotherapy Associates (now part of a private equity firm) $16.6 million settlement with the Department of Justice as some type of celebration against “corporate PT”.  Think again, again.

$16.6 million for Stryker is a couple of circo-electric beds, 5 artificial vertebral disks, and a few implants in a bad week for a company whose revenues are approx 6 Billion and market cap of over 29 Billion.  To a large extent, the settlement probably represents a systematic flaw in a few billing centers.

Let’s recap.  2 employees (quite possibly PT’s but more likely billing folks) filed a whistelblower regarding alleged retainment of excess of duplicate payments received by federal health care programs including medicare, medicaid, and Tricare (don’t forget that Tricare is really medicare from a compliance standpoint).  These employees will get $3 million each as part of the settlement (a reward of sorts for having the courage to file a complaint). 

Physiotherapy Associates in June sold their 475 clinics in 31 states to Water Street Healthcare Partners for $150 million cash plus had to retain this pending settlement with DOJ.  You can to a certain extent consider the $16 M reduction as less in purchase price and their exit from the PT world is now complete (a corporate integrity agreement is probably left in the hands of the aquirers as part of the deal).

I have no idea but my guess is that Physio probably had an outstanding compliance program.  It is a mistake to believe that big PT companies whether they are private, public, or non-profit are lax when it comes to all aspects of compliance.  Just the opposite is typically true.  They understand that bigger means more exposure and they spend disproportionately on auditing and training all aspects of the patient care and billing rules (not to mention accounting, OSHA, and the myriad of HR issues).

The real lesson here is that regardless of your PT clinic’s size, have a strong compliance program.  I can personally attest that many of the PT’s that I have hired from very small private practices or “reputable” employers had no clue that the 8 minute rule exists or that techs cannot treat medicare patients.  In many conversations with new PT’s, I have received feedback that they learn various “rules” while in PT school and then get clinical internships or first jobs where they are ignored in total.  The other lesson is that your compliance program needs to take into account billing issues including refunds to patients and payors.  There are many who mistakenly think that over payments by Medicare can be “credited” toward future patients or “a bonus for not getting paid on others”.

Lastly, if you think you are bullet proof from potential whistleblower suits, think again.  2 folks are $3 million dollars richer from this settlement.

Thoughts?

Larry@physicaltherapist.com

 

Comments

[Arthur Veilleux]

Thank you for including in your post the comment that large corporate own PT clinics are often more aware of and concerned with compliance issues than smaller private clinics. As a PT who works in multiple settings this is also my personal experience. I have learned more about ethical and compliant practice in corporate settings than in private settings.

[sean]

Arthur,
I believe you are correct. As it was my experience working for a large hospital owned group of outpatient clinics, as well as a coworker's statements about USPh.
However, both were put on CMS review due to glaring and mass-disregard for proper documentation requirements.
So the real question is why do the large practices have more compliance education. Is it because accountants run the company and push for numbers, leading to violations? Or is it a proactive stance to avoid problems altogether?
The two cases I've noted were both reactive.

[Selena Horner]

Just because a company has a compliance program does not necessarily mean the company is compliant.

In a hospital situation, the compliance officers are not the "go-to" people that know the answers and know how something is really supposed to be done. The compliance officers are the ones in which issues/conflicts are reported; the compliance officers are the ones that research the rules and regulations imposed for the reported issue/conflict (and to my knowledge they can take their sweet time researching because I don't believe time lines are requirements in the program as to how long it should take to research an issue); the compliance officers are the ones that determine the final interpretation of how an issue/conflict should be resolved. To my knowledge, there isn't anything within compliance programs that suggest that issues reported, researched and interpreted should be revisited within any defined time period after the interpretation to ensure compliance actually occurs.

Yes, the compliance department had "training" but the "training" that I experienced was very general and not department specific (and it was the same training every year). What I experienced was a compliance program in place to satisfy some requirement - and it just went through the motions of doing the bare minimum.

The main reason that I finally discontinued practicing in a hospital setting had to do with the final results of one of the issues I reported to the compliance officers which had an appropriate interpretation and a well-defined action plan for the rehabilitation department. Neither the rehabilitation director nor my direct supervisor implemented the recommendations by the compliance department (and there was a deadline for the rehab department). The compliance officers never revisited the issue and 3 months after the rehab department should have implemented change, I decided that I was not interested in being affiliated or associated with that organization any longer.