LOOK FOR RED FLAGS
1. Make sure you or your loved one is actively participating in therapy. If not, the benefits of therapy will be very minimal. Passive therapy should be implemented only for a short time and a short duration.
2. Look at the therapists' goals and overall treatment plan. Ask questions. Is the therapy functional and is it really going to benefit the patient? Does it have meaning? Does it have an outcome?
3. You have a right to watch the treatment being administered. Does therapy make sense for where the patient is in the rehabilitation process? There may be a good reason for a therapy you do not understand, but make sure the therapist explains it to you and that you are comfortable with the explanation.
4. Look at the bills. Ask about any treatment that seems inappropriate or excessive. If there are discrepancies, raise the issue with department heads and managers, or contact a local ombudsman (see related box).
5. Check for progress. Has the patient shown improvement since the therapy was started? Is the patient making a reasonable amount of progress in a reasonable amount of time? You should be able to comprehend a tangible difference.
Source: Tod Cain, occupational therapist and administrative director of clinical services at Siskin Hospital for Rehabilitation
If you or your family cannot resolve questions or problems with a long-term care facility, contact the district ombudsman. Concerns can include quality of care, financial information, resident rights, admissions, transfer, discharge, Medicaid and Medicare.
• In Southeast Tennessee, call Trudy Mott at the Partnership for Families, Children and Adults: 423-755-2877.
• To reach your local ombudsman of long-term care in Tennessee, visit tn.gov/comaging/ombudsman.html.
• In Georgia: www.georgiaombudsman.com
• In Alabama: www.alabamaageline.gov
Details of an ongoing federal investigation into Life Care Centers of America reveal claims that elderly patients undergoing end-of-life care at several company facilities were pushed to high levels of unnecessary therapies so the company could bill maximum Medicare amounts for profit.
The examples in the federal complaint show a more personal side to the allegations of corporate-encouraged fraud that prosecutors have leveled against the Cleveland, Tenn.-based company.
One segment details the case of "Patient D," a 92-year-old resident at a Life Care facility in Orlando, Fla., who was dying of melanoma in 2007. Though the cancer had spread to Patient D's brain and lungs and radiation treatments had made him "medically fragile," he still was administered two hours of therapy every day.
Two days before Patient D died, he was spitting out blood. Yet therapists recorded 48 minutes of physical therapy, 47 minutes of occupational therapy and 30 minutes of speech therapy in one day.
"The day Patient D died, Life Care therapists recorded 35 minutes of physical therapy and had him scheduled for occupational therapy later in the day," court records state.
Other cases described in court records include:
• Patient C: An "extremely frail" 80-year-old female resident of the company's center in Columbia, S.C., in March 2006 was "very lethargic, hard to arouse" and "required assistance to control her head and to open her eyes." But therapists placed her in a standing frame -- equipment that holds the patient in a standing position -- supporting areas too weak to remain standing. Both the physical and occupational therapists recorded 42 minutes each for the time Patient C spent standing in the frame. The woman died five days later.
• Patient I: A 62-year-old male resident at the Columbia, S.C., center could not walk and was "totally dependent" for "bed mobility, transfers, toilet use and bathing." Life Care billed Medicare for "standing exercises" at the highest level allowed from April until June 2007.
• Patient A: A 78-year-old male patient at the company's Park View Care Center in Indiana was "frail and debilitated" when admitted in early May 2008. Therapists "subjected him" to more than 13 hours of physical, occupational and speech therapies in his first week at the location. Later that month Patient A was admitted to the hospital, then returned to the Life Care facility on May 28 for palliative care. Instead, therapists provided nearly five hours of therapy on May 31 and June 1. Patient A died on June 2, 2008.
Federal prosecutors are seeking treble damages from Life Care for submitting what they have called false claims for "medically unreasonable, unnecessary and unskilled therapy services," and using falsified records to support the claims.
Representatives from Life Care declined to respond to the specific allegations, referring a reporter to an open letter posted by the company since news of the whistle-blower lawsuit broke Nov. 30.
"Contrary to the government's allegations, Life Care's therapy programs improve patients' conditions and their quality of life," the statement reads. "This belief is supported by medical literature, studies, and Life Care's first-hand experience in observing the progress of patients who receive high-intensity therapy."
The company has denied allegations of fraudulent billing, and claims its therapy methods actually saved the federal government as much as $400 million between 2006 and 2010.
Knowing what kinds of therapies are appropriate at each stage of rehabilitation can be a gray area, debated by doctors and therapists.
But there are definite red flags to look for at nursing homes and long-term care centers, said Tod Cain, an occupational therapist and administrative director of clinical services at Siskin Hospital for Rehabilitation, which serves all ages.
Cain said he could not comment about the specific cases outlined in the Life Care lawsuit, but said a pattern in such cases would be problematic.
"With one case it may be valid. You can make a case for medical necessity for a variety of treatments.
But if you're seeing patterns of patients receiving this kind of therapy up to the very end of their life -- that becomes an issue," he said.
Cain said that those undergoing therapy or caring for loved ones in therapy need to be "actively participating" in the process -- asking questions, gauging results and checking the treatment bills.
The whistle-blower lawsuit against Life Care arose from two separate complaints filed in 2008.
Glenda Martin, former staff development coordinator for the company's Morristown, Tenn., facility, complained about alleged Medicare fraud that year. Martin worked at multiple company locations from 1993 until 2007.
A few months earlier Tammie Taylor, a former occupational therapist at the company's facility in Lauderhill, Fla., made similar complaints.
Federal prosecutors sealed the cases and began an investigation that to date has included 150 interviews, more than 200,000 pages of documents and 35 subpoenas in the nationwide company.
Life Care has more than 200 facilities in 28 states. Its estimated revenues for 2011 were $2.69 billion, according to Forbes.com.
Between 2006 and 2011 the company took in $4.2 billion in Medicare re-imbursements.