Complaint·December 4, 2024

It was alleged by the reporting parties that staff are falsifying records when a resident is seen for Physical and/or Occupational Therapy and that the residents in care are being billed for those services. No additional information was provided by the reporting parties about the specific resident(s) who were claiming this allegation, or how the reporting party acquired the information. No contact information was provided, so CCL was unable to contact the reporting parties to obtain additional information about these allegations. To investigate the allegations, LPA Phillips conducted an initial tour of the facility on 12/07/2023, conducted a file review, acquired various documents including therapy chart notes for various residents, interviewed the Director of Nursing and Rehabilitation Director and conducted additional interviews with 2 residents. On 12/04/24 LPA Rankin returned and conducted detail interviews with the Director of Rehabilitation. During the discussion the Director explained that staff have set schedules and hours they are to work for the week, that there is a percentage of that time that must be spent in direct therapy with residents. Each morning management reviews the recorded hours and activities conducted to ensure staff are completing assigned tasks, that they able to account for staff daily activities. Additionally, the charting records have a minute account for each activity or type of therapy conducted with each resident as well as detailed notes of what was done, how many repetitions, and the progress of the resident. When therapy notes were reviewed LPA observed that the start and completion dates matched on all records and that the time stamp of when the therapist electronically signed was within the same date of when the services were provided. LPA reviewed the following dates of services 12/01/23, 12/05/23, 12/06/23, and 2/19/24. The charting system then transfers those notes, billable hours, and medical codes to the facilities system so that billing invoices can be generated. LPA noted that the minutes charted by therapists are turned into what Medicare deems a “unit” based on the medical code and the time provided for that code. At the end of the month, these records are reviewed for accuracy by the Director of Rehabilitation to ensure that what was captured by the facilities system matches the therapy recorded time/units. Continued on 9099-C During the review of these systems LPA was provided copies of invoices that are sent to Medicare, those codes, dates, and billed units were reviewed specifically for services provided to the Assisted Living residents from the therapist #1 (T1). LPA observed all records, notes, and units were consistent. A review of T1’s scheduled hours worked during the invoices reviewed were consistent with the time stamp of T1’s signature for the notes. LPA noted that T1 started with the facility early November of 2023. Director stated there was a time when T1 was spoken with, but it was due to T1 being new to the processes of the department and was stated as a one-time occurrence, but it was not in regard to any falsifying of records or billed units. When asked how staff are managed or monitored, the Director stated the following are reviewed daily: therapist notes, hours of work, and any inconsistencies in timecards. If there is a concern a 1:1 is done with staff to council them on correcting any error. LPA also interviewed Therapist #2 (T2), T2 also detailed their charting processes, record keeping, and how any issues are addressed. T2 stated if a concern is brought regarding another therapist, by family or residents, it is encouraged that they bring the concern to management. Both T2 and the Director stated there is often a cognitive element that can confuse services that were provided, or the amount of time spent in therapy. There is also the added note by both parties that some services are not “exercise” as a resident may typically understand, but more in assistance in daily living practices where a therapy is provided to residents in their living environment where therapists help them in daily practices that need to be reviewed or adjusted for the residents needs and safety. LPA interviewed 2 residents, both residents were unable to describe their therapy, but did state that the facility ensure that they are provided what is needed in a safe and timely manner. Both residents expressed that they receive good care, and that staff are attentive and that should there be an issue they or their representative are able to address those needs. Based on the investigation, there is insufficient evidence to support the claim that Staff have falsified residents’ medical documentation and that staff billed residents for services not rendered. This allegation is deemed Unsubstantiated at this time. No deficiencies cited. Exit interview conducted. A copy of the report was issued.