List date(s) this work was published or aired.
Jun-12
Provide a brief synopsis of the story or stories, including any significant findings.
Fraud and abuse in physical therapy: Sometimes it’s intentional. Sometimes it’s not. What is known is that fraud and abuse throughout just the Medicaid portion of health care has been estimated to cost anywhere between $48 billion and $1.2 trillion a year. This article explored the range of fraud and abuse, explaining what it is, how it occurs, and what can be done to prevent or stop it. Various sidebars addressed definitions, the estimated cost of both fraud and abuse, and resources for physical therapists to help prevent fraud and abuse.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Reports, studies, substantial online research, and other materials were reviewed. These helped provide a framework or structure for the portion of the article dealing specifically with physical therapy.
Explain types of human sources used.
Many physical therapists were interviewed. Some had inadvertently committed abuse. Others consult with physical therapists to help prevent fraud and abuse.
Results:
The article generated positive feedback from physical therapists. It also prompted a “Letter to the Editor” that praised the overall thrust of the article, but felt that one sector (skilled nursing facilities) may have been overrepresented in the examples.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
As noted above, the article prompted a “Letter to the Editor” that argued that skilled nursing facilities had received undue attention. However, the letter also conceded that “the SNF setting is not an easy one in which to work. It is true that there are documentation challenges . . . ” We were pleased to print the letter with only minor edits, but felt that, overall, it supported the content of the article.
Advice to other journalists planning a similar story or project.
It is vital to understand the difference between fraud and abuse; they are very different problems. It is also important to understand the extent of the problem and how the calculations or estimates are made. In the case of Medicare fraud, numbers range from $48 billion to $1.2 trillion. Understanding those calculations helps a writer present a more accurate picture to the reader. Several of the most useful examples in the story were provided by a consultant, who directed us to physical therapists who were willing to share their stories. Several were very willing to help with the story so that others might avoid the problems they encountered.