8
Ethics for the Pennsylvania Physical Therapy Professional: Summary
MEDICARE FRAUD AND ABUSE
• Unbundling: Arranging the services differently for higher profits • Kickbacks: Gifts or money required to use product or service • Off-label marketing: Prescribing a drug for unapproved uses Protect Thy Patients and Thyself Avoid ethical dilemmas by using the acronym PROTECT THY PATIENTS and THYSELF: P— Put a copy of your licensure law on your desk and read it! R— Report ethical and legal violations. O— Open your eyes. T— Tell them you want it in writing or in email. E— Encourage ethical behavior. C— Complete, thorough documentation. T— Think! T— Take the patient’s interest above all. H— Handle situations as they arise. Y— Yearn to learn. P— Plug into your professional associations. A— Ask a lot of questions. T— Train and supervise all subordinates properly. I— Internet sources. E— Establish a relationship with a mentor or peer. N— Never fall behind. T— Take a good look at the professional literature. S— Surf the Internet for regulatory changes. And T— Take the time to read your code of ethics. H—Hand over patients to those with expertise. Y— Yield to the dictates of payers. S— Save a copy of correspondence. E— Explore all alternatives. L— Look at professional association/ licensure homepages. F— Fill out all forms accurately and truthfully.
Fraud and Abuse Fraud: The provider of therapy services knowingly or willingly lies in order to get paid. Abuse: Medicare pays for an item or service it should not, or any time a provider bills Medicare for services not medically necessary. The Office of the Inspector General (OIG) fights Medicare fraud and abuse through task forces and audits. Failure to report illegal activity may result in federal criminal charges of conspiracy. Fraud and Deceit Fraud is more than unfaithfulness or dishonesty. It is blatantly indulging in actions that cause harm to patients, other healthcare providers, and society in general. Fraud can involve: • Billing for services which were not rendered • Billing in excess or inaccurately • Requesting to be done or performing • Accepting kickbacks for patient referrals Documentation Fraud in Healthcare • Duplicate submissions: Billing for the same service twice • Upcoding: Billing for services that are more costly than the actual procedure that was done is upcoding and is fraudulent • Violating disclosure agreements: Withholding relevant information or providing false or inaccurate information • Excessive services and unnecessary services • Misbilling: Billing for things that never happened services that are unnecessary • Misrepresenting treatments • Falsifying patient diagnosis
Powered by FlippingBook