Failure to Provide Timely Physical Therapy Due to Insurance Transfer Delays
Penalty
Summary
The facility failed to provide timely Physical Therapy (PT) services to a resident who required skilled PT following admission with multiple diagnoses, including hemiplegia and hemiparesis after a stroke, COVID-19, diabetes, hypertension, major depressive disorder, anxiety, muscle weakness, and chronic pain. The resident was cognitively intact and required substantial to maximum assistance with transfers, showers, and dressing, as documented in the Minimum Data Set. Despite a PT evaluation indicating the need for skilled therapy to assess functional abilities, enhance rehabilitation potential, and improve mobility and safety, the resident only received PT once since admission. The delay in therapy services was due to unresolved insurance transfer issues following the resident's move from another facility over 18 months prior. Staff interviews confirmed that the resident was not receiving therapy because her insurance had not been transferred to the local county, and no one had assisted her in resolving the issue. The Business Office Manager and facility leadership acknowledged that the insurance should have been changed months earlier, and the lack of assistance resulted in the resident not receiving needed PT services, which was confirmed as a violation of resident rights.