Related service providers: do you bill dishonestly?

amother

Red

Tue, Jun 27 2017, 11:48 am

I am an SLP and unfortunately there are LOADS of ways to be dishonest, some a lot more innocous than saying you saw a student when you totally didn't or billing for one hour instead of 2? How about working for 20 minutes and billing for 30? How about keeping the student the full 30 minutes, but just letting the student play with a toy while you jabber on the phone? How about seeing several students in a group and billing each on as an individual session? As I said there are loads of ways. I can think of more still. The above are all examples I've seen in personal experience. It's awful. No, I don't think it's the standard in the industry, but even if it were - so what - it's totally assur! And I would never work for an agency that made me do that even if it were the only job around. If your agency required you to work on Shabbos wouldn't you quit?? Why would requiring you to be dishonest be any different!?!?

Honestly, I find it a big nisayon not to end the sessions a drop early, etc, but I work really hard to be extremely scrupulous. This is one of the three big questions that we are going to asked after 120, if we were honest in business - and I really don't want to burn for an extra few dollars. And I like to think that being honest in my business dealings should be a zchus for parnassa.

cnc

Tue, Jun 27 2017, 11:50 am

FYI
I have a child that gets related services and I get a billing report from the DOE every couple of months listing what the provider billed for and asking me if this is accurate. ( It always is.)
For some reason, I only receive this for 2/3 providers. I'm not sure how they determine who to check up on.

I did have a provider that was billing for an extra session weekly when she had told me she can't actually fill it but I got rid of her for other reasons because her dishonesty carried over into many other things and she was very unqualified. ( I only realized that she was billing extra when she filled out a form for my yearly meeting.)

amother

Denim

Tue, Jun 27 2017, 12:01 pm

My child gets services through a frum agency in Lakewood - I find their therapists to be scrupulously honest. They literally work with the child for every second that they are supposed to be working (and more.) Their paperwork is squeaky clean and I am so impressed by their level of devotion - I feel it goes together. They want to help my child so they squeeze every minute of therapy into their time slot.

I had a non-jewish therapist from a different agency at one point and she was never even in my home for the full hour she claimed - let alone working with my child!

amother

Burgundy

Tue, Jun 27 2017, 3:22 pm

I am a therapist and I do my utmost to handle my work in a completely honest way. I am very appreciative to a frum employer early in my career who influenced me greatly in this area. I have definitely observed other therapists conducting their sessions or billing unscrupulously, though no frum therapists that I recall (not too many frum therapists in my area).

I just wanted to point out that depending on the payor, sometimes an hour of therapy is actually 50 minutes of therapy and 10 minutes of parent education/ paperwork/ etc. Please don't assume that your therapist is doing something wrong if she leaves after 50 minutes and bills for an hour (unless you're paying out of pocket, in which case she should have informed you of her policy).

amother

Lime

Tue, Jun 27 2017, 6:14 pm

There are times that I see a child but can't bill. Most of the students on my caseload are approved for sessions 3 times a week, but the yeshiva I work in wants me to see each child every day. Some kids are grouped and some are individual. I make sure that I don't bill for more than any child's mandate, that I don't bill if I didn't see a child on a particular day (even if it comes out to less than the mandate), but there are times I bill a group session as individual because not all the kids were mandated services that day. I wish that all my kids were approved for the amount that they need so I could bill accurately. It would make it so much easier. I keep a calendar where I mark down who I did or didn't service each day and at the end of the month, I have to figure out who to bill for which time slot since I have too many 3 day a week kids who I see 4 times a week. It means that kids are sometimes billed for other kids' times, but they were seen that day for that amount of time, and the kid who was seen at that time already exceeded his mandate for the week. Do I like doing it this way? Definitely not. It would be much easier to bill for my actual schedule, but school policy is school policy. Nobody is being billed for more than they were serviced.

seeker

Tue, Jun 27 2017, 8:43 pm

amother wrote:

I'm not sure I followed everything you said but regarding when you see a group and only bill for an individual because the others are exceeding their mandate, that's absolutely fine as long as you're OK with the decreased pay because billing for an individual is less than billing for a group. As long as the child is mandated for group sessions, the other kids in the group do not have to be DOE kids. The only thing that would be problematic from an honesty perspective is doing the opposite - overbilling for a group session when really you didn't work with all the kids.

I consider myself honest but if you were to follow me around with a hidden camera and go through it with a fine-tooth comb you might have some questions. Here are some of the answers:
- For some jobs you can only bill in half-hour increments. If the child needs to leave 10 minutes early or I arrive 10 minutes late or something, then yes I'll bill for the half-hour - but then I'll make up for it by staying late a different day or not billing for a similar half-session.
- No, I do not think I need to be actively teaching for every single billable second. I have kids with 2-hour sessions. They would go crazy if I heckled them to learn the entire time. So if you see me apparently just watching the kid do nothing, odds are it was a professionally calculated decision that this was in the child's best interest at the time, and it isn't wasted time if it will enable the child to work better afterward.

Happydance

Tue, Jun 27 2017, 8:44 pm

I really really struggle with this.

I work as an OT in subacute rehab

What's normal, what's honest

When exactly does my session start? The minute I start discussing the pt so I can gather supplies to start my session or the minute the pt is within line of sight, or the minute she engages in the exercise

Can I round to the nearest 5 minutes?

What if a pt is very talkative and much of the session is interrupted by non productive conversation? Do I have to exclude that non skilled treatment time?

I am expected to document during the session, how many minutes between activities is normal to give so I can enter data. If I'm in.middle of typing a sentence and the pt is ready to resume, is it stealing to finish documenting so as to not lost my train of thought?

If everyone else follows above practice, may I as well or do I have to go above the norm?

Etc etc etc

These questions are constantly rolling in my mind as I work.

seeker

Tue, Jun 27 2017, 8:53 pm

Wow, you're thinking this through hard...

For most of my jobs these things were dictated. For example, in the past there was a rule that 5 minutes per SEIT session could be spent on paperwork etc, but now the rule is that it can't. I do jot very brief notes to myself during many sessions because I will have to report about them afterward and it's the only way I'll remember the details of what happens! But obviously I'm not composing essays at that time.

Likewise, preparing supplies and discussing students with teachers/parents/etc is also considered "related activities" not to be included in session time. However I have a student who tends to make a wreck out of our working area, and my times are slotted together with some buffer but not THAT much, so I try to include him in the cleanup but if he's not cooperative that day then I just return him to his caregiver a couple of minutes early so I can leave the space decent.

I consider the session started when I start to interact with the student. "Line of vision" doesn't qualify but greetings and pleasantries are part of a session even if those aren't the actual goals. It's a prerequisite to working with anyone.

Chatty clients are also like that - you have to keep things warm but you also need to redirect so it doesn't take you away from your work more than necessary.

Unless contracted, these things are all judgment calls and I think we can exercise professional judgment during these times without worrying about whether we're "stealing" seconds here or there.

amother

Navy

Tue, Jun 27 2017, 8:53 pm

FYI: in early intervention in NYC parent education is part of the billable part of the session. If the parent spends a lot of time talking with you, that is considered time from the session. This is because they use an embedded coaching model. It is more important to them for the parent to learn and implement the skills than for the therapist to spend the entire 30 minutes hands on with the child.
Ideally, the session would look like:
Review of skills learned last session with parent and child
Changes or adjustments to activities demonstrated to parent, and parent demonstrate mastery (as needed)
New activity demonstrated to parent, parent demonstrate mastery, and discussion of how to implement into daily routine.
Review of session.
A lot of talking...

Then they write the session note, review with parent and obtain signature.

I know not every therapist follows this model. A lot follow a medical model and that is okay too, because of state regs.

Just explaining why billing for discussion is not usually fraud in the EI system.

seeker

Tue, Jun 27 2017, 9:14 pm

amother wrote:

I'm not sure, but I think spending extra time with a client (because that is what your school or agency requires you to do) is considered a kick back. This is an example of criminal activity that is not technically dishonest from a halachic standpoint. Still, if a gov't funded organization is caught doing this, the perpetrators can be publicly audited or even arrested or subpoena'ed or whatever and we can all sit and moan about the dishonesty that goes on in frum communities.

In what way is this a kick-back? I'm not sure I get it. You mean that it's a benefit to the school in exchange for giving you the cases? I'm not really getting how that can be construed as criminal activity.

I'm not sure how other services work but for P4 SETSS the contract is very clear. You can't receive any extra pay for the services you provide under the contract, so the school can't pay you more for seeing that child but it doesn't say that you can't see the child more than contracted. It would be a conflict of interest if you provided additional services to the child for pay, but I never saw anything against going overtime for free. At $40/hour it's not something most people choose to do!

amother

Green

Tue, Jun 27 2017, 9:44 pm

amother wrote:

This is very confusing. If you have to see each 2-3/week child 5/week, that limits your caseload tremendously. If every therapist is doing this, the school is hiring and paying about 3x as many therapists as they are being reimbursed for services.

How can this work out fiscally for a school?? I'm not trying to make accusations, but I'm a school based therapist too, and schools and programs are struggling right now, closing left and right. Where is this money coming from?