Nursing homes in California – and notably in Orange County – are outpacing the nation in embracing the most expensive form of therapy for their patients on Medicare, triggering an outcry from some therapists who say the therapy is frequently unnecessary.
The Orange County Register reports that 72 percent of Medicare rehabilitation patients in Orange County nursing homes in 2014 received treatment at the highest rate allowed. That compares to 66 percent statewide, and 58 percent nationwide, the CHCF Center for Health Reporting found in an analysis of Medicare data for the Orange County Register.
The cost to taxpayers is upward of $500 per patient per day, contributing significantly to the nearly $30 billion per year that Medicare pays nursing homes for all patient care.
The practice, known as ultra high care, can require sometimes frail patients to receive at least 12 hours of physical, occupational or speech therapy every week. Some therapists in nursing homes say they’re being told to give inappropriate treatment to patients, according to the three major therapist professional groups.
“We get calls from therapists who are being pressured to do practices that are unnecessary or illegal,” said Roshunda Drummond-Dye, director of regulatory affairs at the American Physical Therapy Association.
Melissa Lathon said she personally saw Medicare fraud skyrocket in her 16 years as a social services director at six nursing homes, including three in Orange County. “They would pretty much twist the therapists’ arms and say, we need another week at the ultra high level,” she said. And when she handled patient discharges, “If they still had Medicare benefits available, they would not let me discharge them.” She said she left the field after a supervisor ordered her to fill out a document saying a patient needed assistance in walking when he had clearly shown he was walking independently.
A handful of nursing home therapists have turned whistleblower, filing lawsuits under the federal False Claims Act. In November 2013, Mission Viejo-based Ensign Group agreed to pay $48 million to settle a case involving allegedly false rehab claims at Sea Cliff Healthcare Center in Huntington Beach and five nursing homes in other Southern California cities. Two therapists originally filed the suit. Ensign denied wrongdoing at the time and did not respond to questions for this article.
Pending cases against two of the nation’s largest nursing home chains, HCR Manor Care and Life Care Centers of America, allege managers pressured therapists to step up treatments. They also allegedly administered expensive therapy to dying patients. Both HCR and Life Care are fighting the lawsuits. Life Care has nursing homes in Garden Grove, La Habra and Lake Forest.
The recent $125 million settlement with Kindred Healthcare, the nation’s largest nursing home operator, a company with annual revenues topping $2.5 billion, sent its stock to its lowest point in nearly four years. Kindred denied wrongdoing.