Failure to Provide Required Physical and Occupational Therapy Services
Penalty
Summary
The facility failed to provide required physical and occupational therapy services to a resident who had a history of traumatic brain injury, multiple fractures, and acute respiratory failure following a motor vehicle accident. The resident, who was previously ventilator-dependent and required a gastrointestinal tube for nutrition, had shown improvement and was no longer dependent on these supports. Despite medical orders and therapy evaluations indicating the need for skilled PT and OT to maximize mobility and reduce caregiver burden, the resident did not receive these services as prescribed. Interviews and record reviews revealed that a referral for PT was made, but the insurance company did not receive the request due to errors in the authorization process, including the use of an incorrect CPT code and lack of timely follow-up by the business office. The resident was instead placed on a restorative nursing program, but did not receive the skilled therapy ordered. Staff confirmed that without PT authorization, therapy could not be provided, and the business office acknowledged that the lack of follow-up contributed to the ongoing absence of therapy services.