legal concerns

I recently discharged a pt from PT caseload at a SNF as pt had achieved modified independent to independent level of functioning using RW and L AFO(s/p MVA with traumatic L lower leg Fx and peroneal N. involvement). Tried for four weeks to return some L foot/ankle dorsiflexion with no results. Pt has AFO to maintain neutral DF/PF. The problem is that pt demonstrates behaviors of a symptom magnifier and malingerer as she denies being able to perform at the level of functioning that myself and 4 other professional therapists (2-OT, 1-ST, and 1-PTA)have observed and documented. Pt continues to remain in a w/c despite PT and OT asking her to cease use of w/c approx. 5 weeks ago when it was initially appropriate. Pt was very very angry and disagreed with therapy and nursing staffs objective findings and appealed to medicare board as she realizes that she will no longer be skilled and will bear a financial burden if she stays in bldg (she is in her thirties and is appropriate to return to community living with RW and L AFO she just has no where to go partly due to the fact that she has not pursued any other environment. The QIO (reviewing MD in carge)states that pt will remain in facility and WILL ABSOLUTELY recieve 3 more weeks of therapy. I have direct access in GA with the exception of needing MD orders for reimbursement and it is against my professional ethics to re-evaluate and work with pt as i feel she is fraudulent and has achieved the level of functioning that she has despite the fact that she performs with a self induced debility (only way I know to say it) so as to portray the image that she remains severly debilitated. All of rehab staff and even facility staff agree that pt is malingering. Question: Does this Medicare review board have that type of governing authority over me and can they force me to work with this pt despite the fact that we are well documented in regards to pt physical performance and prowess and the fact that her subjective c/o and presentations do not match our objective findings. Do I have the right to refuse this?

Posted By M. Simmons, MPT on January 07, 2009 at 14:45:01:

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