At-home mental healthcare providers face an ever-present temptation to cut corners on documentation. We're here to tell you to resist it.
After a physician prescribes a course of home mental health treatment, usually for 6 months, Medicare expects that in-home mental health services will be "clinically supervised" by someone with a professional license (like a therapist or psychologist). This clinical supervision is supposed to be regularly documented. But conferring with a licensed professional takes time, as does filling out progress notes and other paperwork. These tasks take even longer when the right person-the licensed professional-actually reviews and signs-off on the paperwork, let alone drafts it. And Medicare won't pay for time spent filling out paperwork even though it is time-consuming and can seem like a "box checking" exercise.
This gives rise to a temptation to cut corners, particularly for the many home mental healthcare providers whose staff lack professional therapeutic licenses and are not subject to routine state or federal inspections.
Rather than obtaining a licensed professional's approval for progress notes and other documentation, a provider may just go ahead and submit a claim assuming the professional would sign the notes, or a provider could even batch sign the notes on the professional's behalf, knowing the professional almost certainly would glance and sign them.
No harm no foul? Not to the federal government. The Department of Justice (DOJ) last year came down hard on a home care provider for allegedly doing exactly this.
Complementary Support Services (CSS), a provider of in-home mental healthcare to children and adults, allegedly violated Medicare's clinical supervision requirements by "batch signing" progress notes for home visits, instead of obtaining sign-offs from licensed professionals acting as clinical supervisors to its staff. CSS allegedly submitted more than 85,000 claims to Medicaid over nearly a decade that may have suffered from this deficiency.
Notably, aside from a separate allegation of billing for time spent filling out paperwork, the government did not publicly accuse CSS of billing for unnecessary or inappropriate care, even though press reports suggest such claims might have been supported. Former CSS employees told reporters that CSS staff would sometimes fill progress notes with everyday activities like "people-watching at the mall," "grocery shopping," and "pumpkin carving" as though they were therapeutic treatment. Other times, only one sentence was provided describing the therapy, such as "had coffee with client." And sometimes, old progress reports were cut-and-pasted to create new ones.
None of this made it into the government's allegations. Rather, merely for batch signing progress notes and improperly billing paperwork time, CSS received a corporate death sentence. In a settlement with the DOJ, CSS agreed to pay $4 million to the government, two of its executives paid fines of $400,000 and $120,000, and CSS was permanently barred from participating in state and federal healthcare programs.
This is a cautionary tale for home care providers tempted to cut corners in documenting their work. Providers who believe they are providing quality, medically necessary care owe it to themselves (and to their patients, and to the feds) to keep records worthy of that care.
To a state or federal prosecutor, an assumption that a licensed professional would support a course of treatment is not a substitute for the professional's actual approval. And although it may seem like the government does not review-carefully or not-this paperwork when submitted, it only takes one complaint to derail a company's future.