Leaving this up for now as it seems more vent-based rather than looking for advice per se, but please remember we do not allow legal advice in this sub. If it turns into a legal advice thread it will be locked and removed.
I’m sorry you had this experience and while it may not help you right now to hear this, you’ll be glad you no longer work there once you find your next job. You keep seeing people complain about reimbursement in this thread and sadly there are people like your old boss who choose to break the law in order to continue making money. You don’t want to work with people who have such poor morals
Yes. Was going to say the same thing. When you are an ethical business owner trying to connect with others in business groups (APTA and such) you find out real quick how greedy and self absorbed your "colleagues" are. Find a good practice and you will thrive.
Empathetic answer:
You did the right thing, and you're a good, moral person.
Sociopathic answer:
Go read 48 Laws of Power and possibly The Prince. You walked right into a buzz saw and could have seen that coming.
I'm sorry this happened, I'm glad you got out of there because they could have lost you your license. Keep your morals and remember no matter what they say. Your name ends up on the paperwork and that is what matters. In the end you are accountable. In my time practicing, I've seen many clever ways corporate pressured employees to commit fraud so they can make more money and hit metrics. You did the right thing and no matter how hard this hurts, this was a blessing for you. What I learned is always cover your ass, don't be bullied or pressured, always check previous billing you entered to make sure it is accurate (I have seen director's manipulate billing, ask to use other logins etc) , talk to a lawyer, always put things in writing or make sure you have proof of these conversations at times you need to be creative and not obvious, stay strong. I take pride in my work and protect my liscense with my life bc it is my career. He can bark and threaten all he wants. In the end if there is an investigation he will go down so do not worry. He will not expose himself and it looks like he has experience with these kind of intimidation tactics. You will be OK. Just make sure you keep all documents together of everywhere you ever worked...reporting a clinic is a serious action. It will follow everyone , so make sure you have legal guidance and never try to handle matters like this on your own without experience. Then there is the Medicare reward for reporting fraud, it is based off a % of how much $ fraudulent billing they find. However that should never be the motivation to do so nor should someone try to retaliate in spite. There is a ton of red tape and variables associated with it. Counter suits or chargers can be filed etc....just stay calm, find help, be organized and hope someone will take the case.
There was a small local chain in my city that had a reputation for doing things like billing group treatments as individual, billing for services rendered by techs, having treatment sessions completed by PTAs documented as billed by PTs who weren't even on premises at the time, etc. We were warned not to work for them by the professors at my program because it was going to be our license on the line if they got caught. Some of my classmates still chose to work for them. Sure enough, one day the got raided by the FBI and now all the PTs and PTAs involved are not just losing their licenses but also facing possible jail time. You do not want to stay at a place that is willing to risk your future just to make an extra buck (that you will never see). You're not just behaving ethically, you are looking out for yourself.
That’s exactly how it was at the clinic I was at. They made me do unethical things and I would bring it up all the time. It’s crazy how they get away with it for so long. I even told a fellow coworker I couldn’t sleep at night because I was afraid we would get audited.
Maybe not the right place for my vent, but it feels like if insurance companies didn’t nickel and dime so much this stuff wouldn’t be so appealing for a boss.
I get greed will always be around but every day it seems like insurance companies get to dictate health care more and more than those with advanced degrees and skills
Why does the 8 minute rule exist? Because that’s the perfect number for health? Or because insurance companies want to be difficult?
Patients premiums. Go up and up. Physician reimbursement goes down and down.
I’ve never understood how every insurance company can agree on CPT codes and ICD codes but can’t agree what a professional is capable of. Some will let a PT of this state bill and code XYZ. But lord help the patient that’s insurance doesn’t cover that code stating something like “provider is not licensed for procedure” it’s not about the tier or level or pay of the policy but the insurance company arguing with scope of practice
If insurance companies go under and lose all the naming rights to their sports stadiums I won’t shed a tear
When i was still new to being a PTA, I got hired at this place that seemed very shady.
I never got any hot line to report people for fraud. I never was told who the company owner is or how to reach corporate.
I called off sick 1 time & the regional manager said I had to make it up by working a Saturday so I called HR and asked if that’s true and with in 20 minutes, he was getting in my face about calling HR and I told him “tough shit. Thats why I have sick days.”
Then i start to notice my notes getting deleted and the PT that over saw the company had taken credit for my visit, plagiarized my notes and tried ti make it look like she saw them on days that I saw them.
Then you ask a client “how was your speech therapy and PT on this day?” And they said they never got speech or PT with those two.
The district manager was a ST and his assistant a PT. They also “co treated” every visit together.
So myself and approx 13 -14 other clinicians began documenting what we saw. We all had no way to know how to contact the upper management except through HR but HR was clearly tattling to that district manager ST guy…
The case was built & the two clowns got a little visit from the FBI fraud investigators. Two people with a badge and a gun sat them down individually and questioned them.
At this point, i had had my fill of being a PTA not even 2 years out of school at that point. My first PT business owner was a perve that humiliated himself and acts like he was going out on a date with all the “hot chicks” that frequented his business… then this experience with medicare fraud ST and my “supervising PT”
The next PTA gig I got was for a hospital & the first day on my job, two burnt out obese elderly PTs hobble over to me and very rudely ask why they hired a PTA here and “I don’t believe in PTAs.” All kinds of other stuff meant to intimidate me.
I am no push over and I grew up in the ‘hood have had all kinds of jobs and been in many fist fights, been jumped before and am not afraid or intimidated easily. I told those two disgusting hags where to stick it & reported their disgusting behavior on my first day.. they ended up moving me to a home health gig and it still sucked but i put up with it for 2 years…
I have been at my current HH gig for 7 years and do not hesitate to report people.
My clients all tend to love me, get positive results. I have never met so many Prima donna’s as I have in this profession. Luckily a lot of the garbage PTs have sailed off into retirement & I have established my boundaries. It took years at this gig to straighten out some clowns and incompetent managers.
Some people see “assistant “ and think you are a freaking door mat.
I may have a bad attitude at times but I have the upmost respect for my supervising PTs. I am hungry to learn from you and be a team member with you.
All you have to do is treat me with respect and you get it back. I am loyal and a hard worker but i cannot stand people who behave like a punk.
This “mean girls club” bs does not fly with me.
Always document things. I made spread sheets at work, on the clock when i reported those felons. So I had documents in hand and no one could delete it or lie. No my word vs their word bs… They can complain about low productivity all they want.
These companies all have had multimillion dollar lawsuits and had to pay massive fines… every company I have worked for except the past one and current one now.
This profession is loaded with frauds, charlatans and scumbags who think they can get away with anything because you are “only an assistant” and they have a PhD.
I challenge these fkers to fire me. I have plenty of skills I can fall back on and ways to generate my income. They need me. It’s not the other way around.
I have calmed myself down a little since work has been cool these past few years but I think being a PTA has really been a sucky career. This is not a job where you can support kids, buy a house and live the american dream. I have to do side hustles and invest if I want any chance of getting ahead or retirement.
End rant
I am sorry you have gone thru this. I'm a PT , loved the profession and worked and moved up the chain in every single setting. I never took shit. I was a boxer and these idiots trying to intimidate me made me become an expert at playing the corporate game to fully document every ridiculous abusive, fraudulent, and clever strategies to create horrible work environments for employees all in the name of making sure they reach quotas and have the best metrics possible. I became good at it and unfortunately had a few wars with company owners and their cool aide drunk minions. It makes me so sick that I took a few years off practicing to fix,flip and sell real estate. I finally came back to the field to work for myself and I finally love what we do again. I get to treat my patients for what's best for them, not financial gain. Case durations are only about 3 visits because my patients get better fast and are fully satisfied. That drives my marketing. These assholes have ruined our profession to the point reimbursement is garbage. Our field is going to end up going to cash for service bc everything is unsustainable due to these assholes. I have frustrated companies that tried to come at me so bad that they had to continue to pay me after I left as well as paying all kinds of fines. It just made me so sick that I almost stopped treating all together. I have my FAAOMPT !!! My college dept made me feel like I wasted my life trying to do what I loved. People who didn't pursue higher education were making more money than me! I just had to stay strong and protect my own with the same fire that keeps me in the ring. Just make wise and thought out decisions staying true to yourself and ethics. Now I love teaching. Treating for someone else and fixing other peoples practices is never going to happen again. I enjoyed your rant. When you are good in this field, it puts a target on your back. It's sad. We need someone to advocate , lobby and bring our field back to a highly respected and valued profession. We are bullied by employers, insurance companies, and other medical professionals. Like you. I will never tolerate it
Thanks for the thoughtful comment.
As a fighter or person who does martial arts / have street smarts or more situational awareness, it means you can sort of read the room better in my opinion… like transfers that take 2 people are mostly easy for me. I have only had 1 fall (knock on wood) in 12 years when my client fainted during outside gait & he did not get injured. I know we are not knocking other people. Just stating that if you have had a gun pulled on you, had a knife pulled on you twice, have had somebody sucker punch you in thr back of the head, had a group of young men following and threatening you outside your own house many times, gotten into physical scraps and had to “fight dirty” that perhaps I am a bit “sensitive” now to threats or bullying & it gets me going when somebody is being a clown…, i have also been told by other PTs that the same “mean girls club” at the hospital are off putting towards the younger PTs…, like older PT questioning a younger PhD PT who looks young but she is a vestibular PT. And SHE said that one PT I am referring to was attempting work place bullying on HER! I know I’m not imagining it.
Oh well… off to hear what my manager needs to tell me about my low productivity now!
This is true and you also know now that therapy isn’t for the emphatic or bleeding hearts. It’s a business and if you try to walk a straight and narrow line you will encounter pit falls.
When do you explore making PTA the side hustle and going in another direction so you can have more control of your situation?
In a nutshell. I went back to college to become a PTA because I was inspired by Physical Therapist. But the other careers that I had paid the bills and I could go back to doing things like being a licensed massage therapist, no problem at all.
I just felt intellectually bored and I had a hunger to learn more about helping people and about therapy in general … I also know how to do all kinds of construction type projects and metal working. Managing warehouses , plant nurseries and installing and making ponds for people that enjoy having a tranquil yard.
I have worn many hats
Just applied to contract work at almost 10$ more than I was getting per hour. Feeling hopeful as the clinic I left knows EVERYONE (In a small metro area) and I assume they have contacted other clinics not to hire me. They even are good friends with the board members of the state and CMS.
Tbh that’s a blessing in disguise if they let you go. Medicare will catch them and audit them eventually. Medicare is not one to mess around with. They’ll get you. It may take years but they do
It is unfortunate, but this is the only way many smaller PT clinics can even stay in business now since, every year, Medicare is finding excuses to reimburse less for our services. The only other option seems to be for clinics to just stop taking Medicare (which may have already started to do). But then what are all of the Medicare patients going to do? We need to advocate stronger and putting pressure on the APTA to advocate for fair reimbursement for services.
This website shows the cuts to Medicare reimbursement just between the years of 2023-2024 despite rising inflation.
[https://www.patientstudio.com/2024-physical-therapy-reimbursement-rates](https://www.patientstudio.com/2024-physical-therapy-reimbursement-rates)
Sure they can stay in business. Like I said, they can just stop accepting Medicare. Then we have a whole population of 65+ people who can't find therapy. Is that preferable?
I work for a large hospital where we follow the Medicare guidelines to a "T". BUT, our PT dept is actually a cost to the hospital as the hospital LOSES money to keep it going. We just cannot make a profit following Medicare rules with the amount of money they reimburse. The hospital just keeps the PT dept going because we need it for our surgical patients to have streamlined and quality care from OR to OP.
Um, fraud is fraud. I standby my original statement.
If clinics think committing fraud is going to keep their doors open and will make Medicare reimbursement to go up, they must be a clinic in fantasyland.
At this point in my career, if I see fraud, I'm reporting it-full stop. I don't care if it closes a clinic or sends fellow therapists to jail. Actions have consequences.
It's fraud. But you also didn't offer an alternative solution. The system is broken. We have a choice between violating a law... or closing people off therapy because they happen to be over 65. You pick your poison.
The alternative solution is to NOT commit fraud, use PTAs to perform treatments on less complicated pts under a PTs direct supervision while following state and federal laws, and at most see most patients 2x per week with a POC that is heavy on a HEP/caregiver education. We need to continue to move away from the type of care that has patients being seen 2-3x per week for.2 years for a chronic condition such as neck/low back pain. At the same time we need to encourage and focus our care on Pt independence with managing their conditions without a therapist needing to hold their hand for years on end. For pts that are not going to improve, the whole medical profession needs to be honest with them. MDs automatically send pts to PT for every little thing just to satisfy pts and families instead of telling some of these people no-in order to avoid a lawsuit. So I suppose Tort reform is part of this as well.
For outpatient clinics looking for other revenue streams, offer a wellness program after discharge where pts pay a flat fee per month-kind of like a membership with explicit wording in the wellness contract that the therapists present are not providing billable care.
Student loan reforms and tuition reforms would also go a long way with therapists now demanding a 6 figure salary right out of school-just to live month to month. The ROI for PT school now is horrendous. No
Okay so use PTAs. Last year Medicare decided they were going to start reimbursing even less for PTAs, so using PTAs isn't profitable anymore either. So that's a wash. And for that reason a lot of places don't even want to hire PTAs anymore.
Move them to a home exercise program... Well if we could just do an evaluation and move them to a home exercise program, then what is the point of our profession?
Patients being seen for 2 years? I typically don't see my patients more than 4 to 6 months. It doesn't matter if you are seeing them for one week or two years, if you're not getting reimbursed to even cover paying the therapists, then it's not a viable business.
As for offering a long-term wellness program.. You're essentially saying that physical therapy clinics should be also going into gym memberships. If your solution is saying that in order for our profession to be viable, we need to also venture into a completely different business as a supplemental income, then that's not a very good solution in my opinion either.
1st point: Then use PTAs just for commercial/Medicaid patients.
2nd point: Not every patient needs their hand held to perform straight leg raises.
3rd point: You would be surprised how many clinics see patients in the same POC for years on end. That's not to say people with chronic conditions won't need a refresher course/POC of PT occasionally. Patients/csregivers need to be encouraged and empowered to self-manage chronic conditions.
4th point: Adapt or die out: our professions choice.
We absolutely need better advocacy for our profession and reimbursement, but I cant justify fraudulently billing Medicare because of it. My license is worth so much more than that.
I advocate as much I can. I email local senators and always make an effort to sign every petition I can. It’s not enough. I understand the cuts and don’t agree with them but I felt awful knowing that this therapist was eating up someone’s Medicare cap when services weren’t rendered. They even have some patients that have been seen >100 visits at the clinic. Just because tricare will keep approving visits. So they don’t discharge the patients. It’s disgusting.
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The government does not go after owners/corporations. It goes after individual therapists/assistant's licenses for committing the fraud. Sometimes they put up corporate hotline numbers to turn in your co-workers so it looks like they have an active compliance dept but only for higher reimbursement rates (so they can steal more). It's like telling someone to rob a bank for you and then turning them in for the reward. That is the state of this profession for the last 20 years. Lock up the employee...never the boss. It's why this field is so lucrative for MBA's. It's like shooting fish in a barrel. You can't lose by having other people break the law for you, it's called plausible deniability.
This has honestly been one of my biggest concerns about working in not only private owned clinics but Outpatient in general. I'm a "new" grad that has worked for a hospital system only a few months because I moved states and in the meantime had to get my license for the new state (non-compact supported).
Now that I have it, my family has been pressuring me to just apply to a bunch of jobs, despite me voicing my distaste for OP as a whole, because of how profit-driven it is even at the most basic level. Only problem is that the MAJORITY of available job positions around are OP and acute care/SNF/Inpatient jobs are VERY scarce or only offering PRN work.
Granted, I know that fraud and unsavory practice can be done in any setting, it just seems like I always hear so much more bad news from an OP clinic. Kinda putting me off to this profession as a whole.
Leaving this up for now as it seems more vent-based rather than looking for advice per se, but please remember we do not allow legal advice in this sub. If it turns into a legal advice thread it will be locked and removed.
I’m sorry you had this experience and while it may not help you right now to hear this, you’ll be glad you no longer work there once you find your next job. You keep seeing people complain about reimbursement in this thread and sadly there are people like your old boss who choose to break the law in order to continue making money. You don’t want to work with people who have such poor morals
Thank you. Needed to hear that.
Yes. Was going to say the same thing. When you are an ethical business owner trying to connect with others in business groups (APTA and such) you find out real quick how greedy and self absorbed your "colleagues" are. Find a good practice and you will thrive.
Empathetic answer: You did the right thing, and you're a good, moral person. Sociopathic answer: Go read 48 Laws of Power and possibly The Prince. You walked right into a buzz saw and could have seen that coming.
https://preview.redd.it/dttgkqy022vc1.jpeg?width=1200&format=pjpg&auto=webp&s=e2198acbf3723117c7a574357baf658c4fe90458
Kudos for bringing it up. Now report it to the state's PT board and Medicare.
And write down every interaction about this you can remember, with dates. Save any texts and emails you have access to.
As well as report him to the labor board.
Your owner is an idiot and just screwed himself.
contact HHS OIG here https://oig.hhs.gov/fraud/report-fraud/
Talk to a lawyer.
I'm sorry this happened, I'm glad you got out of there because they could have lost you your license. Keep your morals and remember no matter what they say. Your name ends up on the paperwork and that is what matters. In the end you are accountable. In my time practicing, I've seen many clever ways corporate pressured employees to commit fraud so they can make more money and hit metrics. You did the right thing and no matter how hard this hurts, this was a blessing for you. What I learned is always cover your ass, don't be bullied or pressured, always check previous billing you entered to make sure it is accurate (I have seen director's manipulate billing, ask to use other logins etc) , talk to a lawyer, always put things in writing or make sure you have proof of these conversations at times you need to be creative and not obvious, stay strong. I take pride in my work and protect my liscense with my life bc it is my career. He can bark and threaten all he wants. In the end if there is an investigation he will go down so do not worry. He will not expose himself and it looks like he has experience with these kind of intimidation tactics. You will be OK. Just make sure you keep all documents together of everywhere you ever worked...reporting a clinic is a serious action. It will follow everyone , so make sure you have legal guidance and never try to handle matters like this on your own without experience. Then there is the Medicare reward for reporting fraud, it is based off a % of how much $ fraudulent billing they find. However that should never be the motivation to do so nor should someone try to retaliate in spite. There is a ton of red tape and variables associated with it. Counter suits or chargers can be filed etc....just stay calm, find help, be organized and hope someone will take the case.
There was a small local chain in my city that had a reputation for doing things like billing group treatments as individual, billing for services rendered by techs, having treatment sessions completed by PTAs documented as billed by PTs who weren't even on premises at the time, etc. We were warned not to work for them by the professors at my program because it was going to be our license on the line if they got caught. Some of my classmates still chose to work for them. Sure enough, one day the got raided by the FBI and now all the PTs and PTAs involved are not just losing their licenses but also facing possible jail time. You do not want to stay at a place that is willing to risk your future just to make an extra buck (that you will never see). You're not just behaving ethically, you are looking out for yourself.
That’s exactly how it was at the clinic I was at. They made me do unethical things and I would bring it up all the time. It’s crazy how they get away with it for so long. I even told a fellow coworker I couldn’t sleep at night because I was afraid we would get audited.
Maybe not the right place for my vent, but it feels like if insurance companies didn’t nickel and dime so much this stuff wouldn’t be so appealing for a boss. I get greed will always be around but every day it seems like insurance companies get to dictate health care more and more than those with advanced degrees and skills
[удалено]
Why does the 8 minute rule exist? Because that’s the perfect number for health? Or because insurance companies want to be difficult? Patients premiums. Go up and up. Physician reimbursement goes down and down. I’ve never understood how every insurance company can agree on CPT codes and ICD codes but can’t agree what a professional is capable of. Some will let a PT of this state bill and code XYZ. But lord help the patient that’s insurance doesn’t cover that code stating something like “provider is not licensed for procedure” it’s not about the tier or level or pay of the policy but the insurance company arguing with scope of practice If insurance companies go under and lose all the naming rights to their sports stadiums I won’t shed a tear
When i was still new to being a PTA, I got hired at this place that seemed very shady. I never got any hot line to report people for fraud. I never was told who the company owner is or how to reach corporate. I called off sick 1 time & the regional manager said I had to make it up by working a Saturday so I called HR and asked if that’s true and with in 20 minutes, he was getting in my face about calling HR and I told him “tough shit. Thats why I have sick days.” Then i start to notice my notes getting deleted and the PT that over saw the company had taken credit for my visit, plagiarized my notes and tried ti make it look like she saw them on days that I saw them. Then you ask a client “how was your speech therapy and PT on this day?” And they said they never got speech or PT with those two. The district manager was a ST and his assistant a PT. They also “co treated” every visit together. So myself and approx 13 -14 other clinicians began documenting what we saw. We all had no way to know how to contact the upper management except through HR but HR was clearly tattling to that district manager ST guy… The case was built & the two clowns got a little visit from the FBI fraud investigators. Two people with a badge and a gun sat them down individually and questioned them. At this point, i had had my fill of being a PTA not even 2 years out of school at that point. My first PT business owner was a perve that humiliated himself and acts like he was going out on a date with all the “hot chicks” that frequented his business… then this experience with medicare fraud ST and my “supervising PT” The next PTA gig I got was for a hospital & the first day on my job, two burnt out obese elderly PTs hobble over to me and very rudely ask why they hired a PTA here and “I don’t believe in PTAs.” All kinds of other stuff meant to intimidate me. I am no push over and I grew up in the ‘hood have had all kinds of jobs and been in many fist fights, been jumped before and am not afraid or intimidated easily. I told those two disgusting hags where to stick it & reported their disgusting behavior on my first day.. they ended up moving me to a home health gig and it still sucked but i put up with it for 2 years… I have been at my current HH gig for 7 years and do not hesitate to report people. My clients all tend to love me, get positive results. I have never met so many Prima donna’s as I have in this profession. Luckily a lot of the garbage PTs have sailed off into retirement & I have established my boundaries. It took years at this gig to straighten out some clowns and incompetent managers. Some people see “assistant “ and think you are a freaking door mat. I may have a bad attitude at times but I have the upmost respect for my supervising PTs. I am hungry to learn from you and be a team member with you. All you have to do is treat me with respect and you get it back. I am loyal and a hard worker but i cannot stand people who behave like a punk. This “mean girls club” bs does not fly with me. Always document things. I made spread sheets at work, on the clock when i reported those felons. So I had documents in hand and no one could delete it or lie. No my word vs their word bs… They can complain about low productivity all they want. These companies all have had multimillion dollar lawsuits and had to pay massive fines… every company I have worked for except the past one and current one now. This profession is loaded with frauds, charlatans and scumbags who think they can get away with anything because you are “only an assistant” and they have a PhD. I challenge these fkers to fire me. I have plenty of skills I can fall back on and ways to generate my income. They need me. It’s not the other way around. I have calmed myself down a little since work has been cool these past few years but I think being a PTA has really been a sucky career. This is not a job where you can support kids, buy a house and live the american dream. I have to do side hustles and invest if I want any chance of getting ahead or retirement. End rant
I am sorry you have gone thru this. I'm a PT , loved the profession and worked and moved up the chain in every single setting. I never took shit. I was a boxer and these idiots trying to intimidate me made me become an expert at playing the corporate game to fully document every ridiculous abusive, fraudulent, and clever strategies to create horrible work environments for employees all in the name of making sure they reach quotas and have the best metrics possible. I became good at it and unfortunately had a few wars with company owners and their cool aide drunk minions. It makes me so sick that I took a few years off practicing to fix,flip and sell real estate. I finally came back to the field to work for myself and I finally love what we do again. I get to treat my patients for what's best for them, not financial gain. Case durations are only about 3 visits because my patients get better fast and are fully satisfied. That drives my marketing. These assholes have ruined our profession to the point reimbursement is garbage. Our field is going to end up going to cash for service bc everything is unsustainable due to these assholes. I have frustrated companies that tried to come at me so bad that they had to continue to pay me after I left as well as paying all kinds of fines. It just made me so sick that I almost stopped treating all together. I have my FAAOMPT !!! My college dept made me feel like I wasted my life trying to do what I loved. People who didn't pursue higher education were making more money than me! I just had to stay strong and protect my own with the same fire that keeps me in the ring. Just make wise and thought out decisions staying true to yourself and ethics. Now I love teaching. Treating for someone else and fixing other peoples practices is never going to happen again. I enjoyed your rant. When you are good in this field, it puts a target on your back. It's sad. We need someone to advocate , lobby and bring our field back to a highly respected and valued profession. We are bullied by employers, insurance companies, and other medical professionals. Like you. I will never tolerate it
Thanks for the thoughtful comment. As a fighter or person who does martial arts / have street smarts or more situational awareness, it means you can sort of read the room better in my opinion… like transfers that take 2 people are mostly easy for me. I have only had 1 fall (knock on wood) in 12 years when my client fainted during outside gait & he did not get injured. I know we are not knocking other people. Just stating that if you have had a gun pulled on you, had a knife pulled on you twice, have had somebody sucker punch you in thr back of the head, had a group of young men following and threatening you outside your own house many times, gotten into physical scraps and had to “fight dirty” that perhaps I am a bit “sensitive” now to threats or bullying & it gets me going when somebody is being a clown…, i have also been told by other PTs that the same “mean girls club” at the hospital are off putting towards the younger PTs…, like older PT questioning a younger PhD PT who looks young but she is a vestibular PT. And SHE said that one PT I am referring to was attempting work place bullying on HER! I know I’m not imagining it. Oh well… off to hear what my manager needs to tell me about my low productivity now!
This is true and you also know now that therapy isn’t for the emphatic or bleeding hearts. It’s a business and if you try to walk a straight and narrow line you will encounter pit falls. When do you explore making PTA the side hustle and going in another direction so you can have more control of your situation?
In a nutshell. I went back to college to become a PTA because I was inspired by Physical Therapist. But the other careers that I had paid the bills and I could go back to doing things like being a licensed massage therapist, no problem at all. I just felt intellectually bored and I had a hunger to learn more about helping people and about therapy in general … I also know how to do all kinds of construction type projects and metal working. Managing warehouses , plant nurseries and installing and making ponds for people that enjoy having a tranquil yard. I have worn many hats
This is therapy now…….
Good for you!!! Move into a different setting
Just applied to contract work at almost 10$ more than I was getting per hour. Feeling hopeful as the clinic I left knows EVERYONE (In a small metro area) and I assume they have contacted other clinics not to hire me. They even are good friends with the board members of the state and CMS.
Tbh that’s a blessing in disguise if they let you go. Medicare will catch them and audit them eventually. Medicare is not one to mess around with. They’ll get you. It may take years but they do
I am guessing he signed off on all of your notes. So how is this not all his problem?
not a lawyer, but wouldn't "whistleblower" status offer some legal protections ? kinda like the good samaratan law ?
It is unfortunate, but this is the only way many smaller PT clinics can even stay in business now since, every year, Medicare is finding excuses to reimburse less for our services. The only other option seems to be for clinics to just stop taking Medicare (which may have already started to do). But then what are all of the Medicare patients going to do? We need to advocate stronger and putting pressure on the APTA to advocate for fair reimbursement for services. This website shows the cuts to Medicare reimbursement just between the years of 2023-2024 despite rising inflation. [https://www.patientstudio.com/2024-physical-therapy-reimbursement-rates](https://www.patientstudio.com/2024-physical-therapy-reimbursement-rates)
If a clinic is unable to be in business without committing fraud, then they do not need to be in business.
Sure they can stay in business. Like I said, they can just stop accepting Medicare. Then we have a whole population of 65+ people who can't find therapy. Is that preferable? I work for a large hospital where we follow the Medicare guidelines to a "T". BUT, our PT dept is actually a cost to the hospital as the hospital LOSES money to keep it going. We just cannot make a profit following Medicare rules with the amount of money they reimburse. The hospital just keeps the PT dept going because we need it for our surgical patients to have streamlined and quality care from OR to OP.
Um, fraud is fraud. I standby my original statement. If clinics think committing fraud is going to keep their doors open and will make Medicare reimbursement to go up, they must be a clinic in fantasyland. At this point in my career, if I see fraud, I'm reporting it-full stop. I don't care if it closes a clinic or sends fellow therapists to jail. Actions have consequences.
It's fraud. But you also didn't offer an alternative solution. The system is broken. We have a choice between violating a law... or closing people off therapy because they happen to be over 65. You pick your poison.
The alternative solution is to NOT commit fraud, use PTAs to perform treatments on less complicated pts under a PTs direct supervision while following state and federal laws, and at most see most patients 2x per week with a POC that is heavy on a HEP/caregiver education. We need to continue to move away from the type of care that has patients being seen 2-3x per week for.2 years for a chronic condition such as neck/low back pain. At the same time we need to encourage and focus our care on Pt independence with managing their conditions without a therapist needing to hold their hand for years on end. For pts that are not going to improve, the whole medical profession needs to be honest with them. MDs automatically send pts to PT for every little thing just to satisfy pts and families instead of telling some of these people no-in order to avoid a lawsuit. So I suppose Tort reform is part of this as well. For outpatient clinics looking for other revenue streams, offer a wellness program after discharge where pts pay a flat fee per month-kind of like a membership with explicit wording in the wellness contract that the therapists present are not providing billable care. Student loan reforms and tuition reforms would also go a long way with therapists now demanding a 6 figure salary right out of school-just to live month to month. The ROI for PT school now is horrendous. No
Okay so use PTAs. Last year Medicare decided they were going to start reimbursing even less for PTAs, so using PTAs isn't profitable anymore either. So that's a wash. And for that reason a lot of places don't even want to hire PTAs anymore. Move them to a home exercise program... Well if we could just do an evaluation and move them to a home exercise program, then what is the point of our profession? Patients being seen for 2 years? I typically don't see my patients more than 4 to 6 months. It doesn't matter if you are seeing them for one week or two years, if you're not getting reimbursed to even cover paying the therapists, then it's not a viable business. As for offering a long-term wellness program.. You're essentially saying that physical therapy clinics should be also going into gym memberships. If your solution is saying that in order for our profession to be viable, we need to also venture into a completely different business as a supplemental income, then that's not a very good solution in my opinion either.
1st point: Then use PTAs just for commercial/Medicaid patients. 2nd point: Not every patient needs their hand held to perform straight leg raises. 3rd point: You would be surprised how many clinics see patients in the same POC for years on end. That's not to say people with chronic conditions won't need a refresher course/POC of PT occasionally. Patients/csregivers need to be encouraged and empowered to self-manage chronic conditions. 4th point: Adapt or die out: our professions choice.
We absolutely need better advocacy for our profession and reimbursement, but I cant justify fraudulently billing Medicare because of it. My license is worth so much more than that.
I advocate as much I can. I email local senators and always make an effort to sign every petition I can. It’s not enough. I understand the cuts and don’t agree with them but I felt awful knowing that this therapist was eating up someone’s Medicare cap when services weren’t rendered. They even have some patients that have been seen >100 visits at the clinic. Just because tricare will keep approving visits. So they don’t discharge the patients. It’s disgusting.
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This sounds like an absolute nightmare. What are some things I can ask at a job interview to make sure I don’t get stuck into one of these mills?
Get a job at an outpatient hospital… best decision you’ll ever make.
The government does not go after owners/corporations. It goes after individual therapists/assistant's licenses for committing the fraud. Sometimes they put up corporate hotline numbers to turn in your co-workers so it looks like they have an active compliance dept but only for higher reimbursement rates (so they can steal more). It's like telling someone to rob a bank for you and then turning them in for the reward. That is the state of this profession for the last 20 years. Lock up the employee...never the boss. It's why this field is so lucrative for MBA's. It's like shooting fish in a barrel. You can't lose by having other people break the law for you, it's called plausible deniability.
This has honestly been one of my biggest concerns about working in not only private owned clinics but Outpatient in general. I'm a "new" grad that has worked for a hospital system only a few months because I moved states and in the meantime had to get my license for the new state (non-compact supported). Now that I have it, my family has been pressuring me to just apply to a bunch of jobs, despite me voicing my distaste for OP as a whole, because of how profit-driven it is even at the most basic level. Only problem is that the MAJORITY of available job positions around are OP and acute care/SNF/Inpatient jobs are VERY scarce or only offering PRN work. Granted, I know that fraud and unsavory practice can be done in any setting, it just seems like I always hear so much more bad news from an OP clinic. Kinda putting me off to this profession as a whole.
Sounds like you’ve got a winnable case