Guest guest Posted August 29, 2011 Report Share Posted August 29, 2011 Your Daily Posterous subscriptions August 29th, 2011 USDOJ: Detroit Occupational Therapist Pleads Guilty to Medicare Fraud Scheme<http://ptmanagerblog.com/usdoj-detroit-occupational-therapist-pleads-g> Posted 3 days ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67093497> USDOJ: Detroit Occupational Therapist Pleads Guilty to Medicare Fraud Scheme * * Embedded media -- click here to see it.<http://ptmanagerblog.com/usdoj-detroit-occupational-therapist-pleads-g> WASHINGTON – A Detroit-area occupational therapist pleaded guilty today for her participation in a Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS). Carol Gant, 66, pleaded guilty before United States District Judge Avern Cohn in the Eastern District of Michigan to one count of conspiracy to commit health care fraud. At sentencing, Gant faces a maximum penalty of 10 years in prison and a $250,000 fine. According to the plea documents, Gant was an occupational therapist who worked for Jos Campau Physical Therapy, which purported to provide physical and occupational therapy services. In 2005, Gant was hired by Jos Campau Physical Therapy to create and sign falsified occupational therapy files. Gant created patient evaluation forms for Medicare beneficiaries whom she had never met, seen or evaluated. Gant admitted that she hired an uncertified occupational therapy assistant, who fabricated and signed notes for occupational therapy patient visits that the assistant purported to perform. Gant paid the uncertified assistant for creating these fictitious patient visit notes and countersigned them. Gant also filled out patient discharge paperwork. Gant provided no services to the patients whose files she created and countersigned. Gant was paid for each patient file that she created. Gant knew that neither she nor the uncertified occupational therapy assistant were providing occupational therapy services to the beneficiaries as stated in the falsified files. Gant admitted that between approximately June 2005 and May 2007, she and her co-conspirators at Jos Campau submitted or caused the submission of fraudulent claims to the Medicare program. Gant submitted or caused to be submitted approximately $897,512 in claims for occupational therapy services that were never rendered. Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division, United States Attorney for the Eastern District of Michigan Barbara L. McQuade, Special Agent in Charge G. Arena of the FBI’s Detroit Field Office, and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office. This case was prosecuted by Trial Attorney K. Dick of the Criminal Division’s Fraud Section. It was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Eastern District of Michigan. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the HEAT team, go to: www.stopmedicarefraud.gov. <http://www.stopmedicarefraud.gov.%C2%A0> Contact: Department of Justice Main Switchboard - via 7thspace.com<http://7thspace.com/headlines/392508/usdoj_detroit_occupational_the\ rapist_pleads_guilty_to_medicare_fraud_scheme.html> The effect of therapeutic touch is based on pure chance<http://ptmanagerblog.com/the-effect-of-therapeutic-touch-is-based-on-p> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67360650> The effect of therapeutic touch is based on pure chance by Lundberg, MD<http://www.kevinmd.com/blog/post-author/george-lundberg> There is no “alternative medicine<http://www.kevinmd.com/blog/2011/03/alternative-medicine-problems-patie\ nts.html>.” There is only medicine: - Medicine that has been tested and found to be safe and effective. Use it; pay for it. - And, medicine that has been tested and found to be unsafe or ineffective. Don’t use it; don’t pay for it. - And, medicine for which there is some plausible reason to believe that it might be safe and effective. Test it and then place it into one of the other two categories. Dr. Phil Fontanarosa and I published that statement<http://jama.ama-assn.org/content/280/18/1618.extract>in *JAMA* on Nov. 11, 1998, in a theme issue devoted to the scientific study of “Complementary and Alternative Medicine.” The statement still remains true today. Do you know about Therapeutic Touch (TT)? It is actually about Therapeutic Non-Touch. The theory holds that the human body emits energy fields of a type for which no physical, electronic, chemical, or other scientific modality has yet determined its existence. It further holds that trained practitioners of this craft can detect and manipulate this “Human Energy Field,” thereby promoting healing, by passing their hands at some non-touching distance away from the body and molding the energy to a good effect. Sound good to you? In 1998, we published a paper in *JAMA* entitled “A Close Look at Therapeutic Touch”<http://www.jama.ama-assn.org/content/279/13/1005.full.pdf>by four authors, lead author , at that time 9 years old. The study was for a fourth grade science project. *JAMA* had no policy as to whether authors needed to be above or below any particular age, of a certain gender, skin or eye color, place of birth or sexual orientation. It was the quality and relevance of the science that mattered to us. After a few rounds of peer review and revision, we published it on April 1, 1998. By theory, TT practitioners should be able to detect while blinded an energy field 100% of the time. In this experiment, the investigators demonstrated that trained practitioners of TT, when blinded, had a 50% chance of detecting an energy field. Pure chance; bah, humbug. Needless to say, there was not a uniform reader response. But received the 1998 Ig Nobel Award at Harvard, and delivered the Ig Nobel address at MIT. The science in that article has so far stood that test of time for 13 years. Of course, some of the “alties” and the SCAM…ers (Supplements, Complementary, Alternative, Medicine) still practice Therapeutic Touch; patients ante up good money to pay for it; fancy medical centers give in to their marketing departments to pander to their local markets by providing TT; some medical school professors earn big TV bucks pushing such. And the arbiter, Mr. Google, reports 2,210,000 results when the words “Therapeutic Touch” are entered. Such are the ways of the world. There ain’t no justice. They know not what they do. Viewed another way, even the non-touch of an individual believed by a sick person to be a healer can heal. * Lundberg is a *MedPage Today* Editor-at-Large and former editor of the *Journal of the American Medical Association*.* *Originally published in *MedPage Today*. Visit MedPageToday.com<http://www.medpagetoday.com/> for more health policy news <http://www.medpagetoday.com/PublicHealthPolicy/>.* via kevinmd.com<http://www.kevinmd.com/blog/2011/08/effect-therapeutic-touch-based-p\ ure-chance.html> How to embrace remote meetings — Online Collaboration<http://ptmanagerblog.com/how-to-embrace-remote-meetings-online-col\ labo> Posted 1 day ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67364668> How to embrace remote meetings By Swart Aug. 28, 2011, 9:00am PT No Comments<http://gigaom.com/collaboration/how-to-embrace-remote-meetings/#respond\ > - Embedded media -- click here to see it.<http://ptmanagerblog.com/how-to-embrace-remote-meetings-online-collabo> - inShare17 - Embedded media -- click here to see it.<http://ptmanagerblog.com/how-to-embrace-remote-meetings-online-collabo> - Embedded media -- click here to see it.<http://ptmanagerblog.com/how-to-embrace-remote-meetings-online-collabo> <http://gigaom2.files.wordpress.com/2011/08/422697043_6fc7d03cd7_z.jpg>Consider this: managers spend between 30 to 80 percent of their time in meetings<http://www.computer.org/plugins/dl/pdf/proceedings/hicss/2001/0981/01/0\ 9811072.pdf>and more than 50 percent of them consider many meetings to be a “waste of time.” Ninety percent of managers attribute the failure of most meetings to a “lack of planning and organization<http://yamlabs.com/blog/management_statistics_meetings/>,” and most managers have never been trained on how to host a productive meeting. When you add in the complexity of leveraging the Internet for hosting distributed meetings online, it is even more difficult to ensure a successful result. Without some amount of preparation and planning, remote team members can feel disconnected, disregarded and even unwelcome in meetings. At oDesk, our in-house full-time employees work from home at least one day a week, and we’re regularly collaborating with a team of about 250 remote contractors who act as a crucial extension of our internal team. This has forced us to study how to make meetings work for all involved. We’ve found there are three steps to a successful online meeting: - Be sure you need a meeting to accomplish the desired result - Establish topics and their time allocation, roles and processes (planning objectives, information sharing, problem solving, decision making, relationship building) - Assess your meeting afterwards (results met, process adhered to, relationships strengthened) We started by defining the roles involved in making a remote meeting work: the organizer, coordinator, presenter(s) and attendees. Each role has its responsibilities to the team, and by defining those roles, we’re able to ensure accountability for each meeting’s success and seek out ways to continually improve the remote meeting experience. Adopting these roles has allowed us to make sure members of a distributed team are as active, included, and productive during a meeting as those who are on-site. *Organizer: Setting the stage* Someone needs to make sure the meeting will accommodate all participants. The format of the meeting will largely depend on the needs of the group and the goals of the meeting. The meeting organizer works with the presenter to ensure that the right format is chosen and prepared ahead of time. - *Where will we hold the on-site meeting?* Generally, this will be a conference room or office large enough to hold all the on-site attendees, with the technology necessary to accommodate remote attendees.** - *What kind of access do remote attendees need?* Is audio sufficient, or do they need video of the room? Do they need to be able to see slides or other materials?** - *How will remote attendees “dial in”? *This means choosing the platform of the meeting, which can include a bridge line, Skype, or a desktop sharing/presenting platform such as GoToMeeting.** - *How will we communicate when and how to attend? *Invitees need to know when, where and how to attend the meeting. If remote attendees need to have a login to register or to download and install a plugin, the organizer makes sure they are aware of this potential roadblock and are prepared in advance. - *Is everyone clear on the roles and their responsibilities? *Make sure all attendees are aware of the presenters and meeting coordinator, and share the agenda and best practices with them. *Presenters: Adapting to the environment* Presenters must remember to take into account the remote participants. When you’re explaining concepts or an initiative to a distributed team, will there be visual aids? Do you intend to show something on a computer screen? Does it need to be seen live, as you manipulate it, or can you send a copy of the material, such as a PowerPoint presentation, to remote participants so they can follow along? Prior to the meeting, the presenter should work with the meeting organizer to make sure they—and the facility—are prepared technically to present via local projection and remote platforms. During the meeting, presenters should: - Log onto their presentation platform five minutes early to address any technical difficulties. - Welcome everyone and ask remote attendees whether they can hear and see appropriately - Make sure to verbalize throughout the meeting what attendees should be seeing (slide number, visual cues, etc.) to help flag sharing problems quickly. - Ask whether the remote team has any questions. It can be hard for remote participants to interject or notify organizers of their desire to speak. Give them equal opportunity to contribute by offering them the floor at meeting/slide transitions. - If a contributor is not near a microphone or speakerphone, repeat the statement or question yourself to ensure remote attendees can hear all conversations (since you’ll probably be best situated for microphone pickup). *Coordinators: Keeping everything on track* Identify a coordinator before the meeting. This person makes sure that the technical side runs smoothly and is prepared to respond to challenges as they arise. The meeting coordinator can also be the organizer, but should not be a presenter. If presentations are being made from more than one location, there should ideally be a coordinator in each place. Also, the coordinators should be members of the department presenting the meeting, to ensure that they’ll understand the material being presented, even if they’re distracted by the on-the-fly back-end management. During the meeting, the coordinator: - Facilitates an instant messaging group chat with remote team members, including updating the conversation regularly as problems are recognized and addressed. This IM session allows remote members to communicate technical difficulties or other distractions that need to be addressed without interrupting the meeting flow. - Handles all troubleshooting requiring local action, such as adjusting microphones, encouraging speakers to talk louder, refreshing slide screens, etc. *Attendees: Ready to go * *Attendees have a role to play in keeping the meeting running smoothly, as well. They’re responsible for: * - Logging onto the platform five minutes early to address any technical issues prior to the meeting. - Communicating difficulties during the meeting to the coordinator via the chosen instant messaging channel. *A note on having a solid platform* Often a simple phone call and speakerphone is sufficient, but make sure any printed material, such as an agenda, is also shared with remote participants before the meeting. Depending on your presentation needs, more involved platform options include: - Dial-in conference bridges or direct-dial phone calls - Skype (video and voice chat) - Shared documents (Google Docs) - GoToMeeting/GoToWebinar - WebEx Whatever platform you choose, adapt your presentation to the platform’s strengths (don’t try to present a PowerPoint over a direct-dial phone call), and make sure that everyone is prepared. Check in with remote attendees afterward to make sure they had a positive experience, and work on ironing out wrinkles as they’re identified. At oDesk, we’ve been refining our techniques for years, and we’re progressing toward meetings that are every bit as easy as having everyone under the same roof — sometimes even easier. More importantly, we’ve made sure that our remote workers are able to fully contribute to our success at least as well as if they were in our office. Which is the whole point of what we do, after all. * Swart is CEO of oDesk. He has more than 17 years’ experience leading remote and local teams as an executive at Intellibank, IBM and Pure Software. * via gigaom.com<http://gigaom.com/collaboration/how-to-embrace-remote-meetings/?utm_s\ ource=feedburner & utm_medium=feed & utm_campaign=Feed%3A+OmMalik+%28GigaOM%3A+Tech%\ 29> Health insurers have come up with the idea of the century<http://ptmanagerblog.com/health-insurers-have-come-up-with-the-idea-of> Posted about 11 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67468679> Health insurers have come up with the idea of the century by Segal, MD <http://www.kevinmd.com/blog/post-author/stewart-segal> I have come up with the idea of the century. My idea will make your company the richest in the world while attracting millions of new patrons to your credit and debit card services. I don’t know why no one has done it in the past. It has made the insurers of America countless billions of dollars and now you can profit as well. My only request is that you pay me 1% in royalties for bringing this opportunity to you. Ready? It’s so simple it will knock your socks off. Under your current company guidelines, your cardholder charges a purchase and takes his merchandise home. You charge your cardholder interest and charge the merchant a processing fee. Once the transaction is processed, you pay the merchant the money owed to him. You make a profit off of interest and fees. Under my plan, the cardholders still charge their purchases, pays you interest at a greatly reduced rate, the merchant still pays you a processing fee, and you still process the transaction. Ready to be amazed? Under the new plan, you no longer pay the merchant, you “reimburse” him at a rate you set. Yes, you take a lesson from the insurers of America. You strong arm (“negotiate with”) the merchants by threatening to take their patrons away. By reducing the interest rate your cardholders pay, you buy their undying loyalty. No longer do you have to pay a merchant $100 for a $100 dollar purchase. Now, using your newfound power, you can pay the merchant $60 and pocket the other $40. Your profits will skyrocket. Your cardholder loyalty will grow exponentially. When the merchants protest, you tell them they will have to get rid of waste and tighten their belts. As your profits and power grow, you will be able to “negotiate” better contracts. In years to come, you will drop reimbursements to 50%. You will establish the concept of “reasonable and customary charges.” Under “reasonable and customary,” you will arbitrarily decide what merchandise and services are worth and then reimburse their costs at your new, lower rate. Merchants will complain but customers will love you. Eventually, you will learn about product substitution. Instead of sending your cardholder a $400 Coach purse, you will send them a Goach (generic substitution costing you $10). Your profits will continue to grow. You’ll offer to replace the Goach if it breaks (limit of two replacements). After the second failure, you offer to send a Coach for just $100 more. Your profits will exceed those of the insurance industry. Patients can avoid seeing the docs for their colds but no one can afford to pass on that new dress at Macy’s. Wall Street will love you. Yes, the cost of items sold will rise as merchants strive to keep their doors open. Eventually, you will “negotiate” the cost of items for your cardholders. Owning your VISA card will become a necessity. Paying cash will be unaffordable. Those who do not have a VISA card will either go without merchandise and services or mortgage their house to buy what their family needs. Your company will have transitioned to a near God-like monster, much like today’s insurers. You won’t care; you’ll be rich and powerful beyond your wildest dreams. You’ll fund Congressmen and Senators and presidential elections, owning the White House. You’ll even be able to control the insurers! All of this can be yours for 1% of your profits. Call me, we’ll talk. * Segal is a family physician who blogs at *Livewellthy.org<http://livewellthy.org/> *.* via kevinmd.com<http://www.kevinmd.com/blog/2011/08/health-insurers-idea-century.htm\ l> Unlocking Usual Customary and Reasonable Charges - Jim Hall Impact 05 2011<http://ptmanagerblog.com/unlocking-usual-customary-and-reasonable-char> Posted about 8 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67478189> <http://ptmanagerblog.com/unlocking-usual-customary-and-reasonable-char> *Jim Hall Impact 05 2011 Unlocking Usual Customary and Reasonable.pdf* View this on Posterous<http://ptmanagerblog.com/unlocking-usual-customary-and-reasonable-char\ > APTANJ Wins Lower Rates, Greater Access for PT Patients as State's Largest Health Insurer Concedes to Lower Copays - MarketWatch<http://ptmanagerblog.com/aptanj-wins-lower-rates-greater-access-for-\ pt> Posted about 8 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/people/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=67479945> APTANJ Wins Lower Rates, Greater Access for PT Patients as State's Largest Health Insurer Concedes to Lower Copays ROBBINSVILLE, N.J., Aug 29, 2011 (BUSINESS WIRE) -- Many of New Jersey's physical therapy patients have cleared a health insurance hurdle that will mean lower copayments and more savings, thanks to the advocacy of the American Physical Therapy Association of New Jersey (APTANJ). Beginning September 1, 2011, Horizon Blue Cross Blue Shield of New Jersey will decrease certain copayment amounts for physical therapy visits to a maximum of $30 for insured patients. Many patients had been charged higher copays, some as high as $50 per visit. " This is a long-awaited, constructive change for patients who rely on physical therapy to recover from an illness or injury and to resume their normal routine, " said APTANJ president Mason, PT, DPT. The change in policy was announced by Horizon earlier this month. The insurer announced that this change would occur in order to comply with New Jersey's Minimum Standards for Health, Dental and Prescription Benefits (njac 11:22-5.1-11). " Evidence was presented to the New Jersey Department of Banking and Insurance and ultimately resulted in this 'course correction,' which will impact thousands of consumers in New Jersey, " according to Mason. Horizon also plans to compensate patients affected by this change by December 2011 for any excess copayment amounts incurred for physical therapy services -- as well as those for occupational therapy, speech therapy and chiropractic services -- provided between April 1, 2011 and August 31, 2011. Horizon's members who qualify will be mailed checks later this year to compensate for this retrospective copayment correction. Mason said the excessive copayments were blocking many patients from the therapy that was prescribed to them, particularly in light of the weak economy. This correction allows patients to have the access to therapy they need and to save some money in the process. APTANJ continues to work with the payer community on issues that will improve access to physical therapy services, reasonable reimbursement and administrative processes. Headquartered in Robbinsville, APTANJ represents approximately 2,000 members, including physical therapists and physical therapist assistants. The professional association is dedicated to " promoting the integrity and excellence of physical therapists and physical therapist assistants through the coordination of physical therapy advocacy, education, and resources. " Visit www.aptanj.org for more information. SOURCE: American Physical Therapy Association of New Jersey via marketwatch.com<http://www.marketwatch.com/story/aptanj-wins-lower-rates-greater\ -access-for-pt-patients-as-states-largest-health-insurer-concedes-to-lower-copay\ s-2011-08-29> [image: Posterous] <http://posterous.com> Want your own?<http://posterous.com> Change your email settings<http://posterous.com/email_subscriptions/hash/gspsqucxgqviGogjvCufJwAxB\ xkgmH> Quote Link to comment Share on other sites More sharing options...
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