Consistent with past practice, the OIG report does not identify the six facilities which constituted the sample. The OIG examined both charges and number of visits in determining the number of medically unnecessary services. The purpose of the study, according to the OIG, was to determine whether sufficient evidence of medically unnecessary PT and OT services in SNFs exists to warrant a national study. Specifically, the OIG concluded that overall more than one-quarter of PT and OT services were medically unnecessary at five of the six sampled facilities. The OIG concluded that facilities often use skilled therapists for strength building or endurance exercises which could be performed with the assistance of nursing personnel, and that therapists often fail to cease therapy or move patients into a nursing program at an appropriate time.
Therapists sometimes ignore the resident's prior level of function and set unrealistic goals.
The frequency of therapy is sometimes excessive. The OIG found that some SNF residents were receiving therapies at a level consistent with an acute rehabilitation program, in some cases totaling up to 5 hours per day. The study noted, in particular, residents with severe dementia who received up to 5 hours of therapy per day. Time billed for therapy exceeds the actual time that services were provided. The OIG found that some therapy bills were inflated by including the time necessary to transport residents to a therapy area or time after a therapy session had ended due to resident fatigue.