With regard to the Medicare suit : As a former PAR at Dynasplint, it takes some time to learn the ins and outs of insurance billing in general, and Medicare has it's own rules that are another, more specific set to learn. By the time I understood enough to question how Dynasplint was billing for patients located in SNF's, I was told repeatedly that this was a process that was well settled and DSI's policies were within the rules allowed by Medicare, and that Dynasplint knew what it was doing and the Compliance Department was on top of what the rules were and how Dynasplint complied with those rules. It took time to "get" that this was NOT the case, that how this billing was happening was against Medicare policy and the Compliance Department was well aware that the billing was not following the MC rules ( hence the exit of the compliance manager). It seems reasonable that if Dynasplint bypassed Medicare's rules it would for other insurance companies as well. Humana patients were fit, told their unit would be covered when Humana plainly stated they would not cover Dynasplints.
Rules were broken for the sake of making money. It all comes back to money. And yes, people stayed and did their jobs, knowing rules were being broken, for the sake of their own paycheck. Not pretty, but true. GH believed he was on a moral "high road" with regard to Medicare, and stated " this is how we get policy changed". Looks like that is not turning out to be the case and all the money that came in the door as a result of that improper billing is did no good in the end.
Rules were broken for the sake of making money. It all comes back to money. And yes, people stayed and did their jobs, knowing rules were being broken, for the sake of their own paycheck. Not pretty, but true. GH believed he was on a moral "high road" with regard to Medicare, and stated " this is how we get policy changed". Looks like that is not turning out to be the case and all the money that came in the door as a result of that improper billing is did no good in the end.