lwconsulting

Physical Therapy Fraud Indictment of Owners and 18 Staff – 1 Year Later

It was just over a year ago when the U.S. Department of Justice (DOJ) in the Western District of Pennsylvania announced indictments against Hertel & Brown, an outpatient physical therapy provider, including the owners, and eighteen (18) employees for committing healthcare and wire fraud. This included Hertel and Brown’s billing specialist. The Federal Bureau of Investigation (FBI) showed up at Hertel and Brown Physical & Aquatic Therapy with search warrants and in black SUVs. The…

Understanding PDPM and the SLP Component

For the Speech Language Pathology (SLP) component, the Patient-Driven Payment Model (PDPM) uses a number of different patient characteristics that were found to be predictive of increased SLP costs. These include identification of any diagnosis in the Acute Neurologic clinical classification and identified SLP-related comorbidities.There are twelve SLP-related comorbidities. These include aphasia, CVA, TIA or stroke, hemiplegia or hemiparesis, traumatic brain injury, tracheostomy or ventilator, laryngeal cancer, apraxia, dysphagia, ALS, oral cancers, or speech and…

Will Your Late Entry Process Withstand an Integrity Audit?

In recent months, LW Consulting, Inc. (LWCI) has been assisting clients with responding to Safeguard Unified Program Integrity Contractors (UPICs) and Medicare Administrative Contractors (MACs). During this process, LWCI has observed an increase in denials purely based on delayed or late entries within the documentation submitted for review to the UPICs and MACs. Over the next few weeks, LWCI will be reviewing the Centers for Medicare & Medicaid Services’ (CMS) signature requirements and late entries…