ask the readers: what to do when your employer wants you to break the law

I’m off for yet another foot appointment, so here’s another ask-the-readers question, this one from a recent grad in a tough situation. She writes:

I’m a recent graduate and I took a job as an occupational therapist with a company where I was supposed to be getting paid an hourly wage. During the interview for the job I expected, I was informed of productivity expectations but told that I “should have no problems making it” after a few weeks. Well, early into my second week, my boss called me in and said that my productivity was unacceptably low and that I needed to bring it up to 85% or eventually I would be disciplined. Since then, I have been working very hard to keep my productivity high, but it’s difficult.

For one thing, my employer defines productivity as billable time (time that you are actually providing services to the patient) versus total time worked. There are lots of things I have to do at my job that are simply not billable. Most facilities that I interned at had aides to do unskilled work like disinfecting equipment after patient use and transporting wheelchair-bound patients to the gym. The facility recently cut the aide staff by 50%, which means those tasks usually fall on my shoulders but I can’t legally bill for that. Furthermore, Medicare has specified that the time you spend documenting your treatments (which is a legal requirement) is not billable unless it is performed “point at service” (while the patient is with you receiving therapy). Consequently, the only way that I am able to hit my productivity standard is by busting my rear all day (no breaks, and I try to wait until lunch to use the bathroom) and then finishing my documentation once I’ve already clocked out. The employee code of conduct states that you are not to work while off the clock, but it would be very hard to make 85% without doing that.

The other therapists are having to bend the rules slightly in order to keep their productivity high enough so that they don’t get fired. For example, they may count unskilled tasks like disinfecting equipment or transporting patients as part of the therapy time…which it’s not. That may only add 5 minutes to each treatment, but it’s being billed to Medicare. I just don’t think that’s right.

It’s not fair that I’m having to work off the clock in order to finish my work. I’ve researched and found similar complaints about this employer from former employees. The problem, though, is that I just got this job one month ago and the rehab industry is a very small world. People move around and you never know who you are going to bump into later on down the line. I’m really torn…should I try to stick it out for a few more months? Should I resign ASAP? I’ve even thought about reporting this to somebody, but I don’t want this to come back to bite me and I don’t want the other therapists (who are really victims of this whole thing) to wind up getting in trouble.

What should I do?

{ 55 comments… read them below }

  1. Eric*

    Ask for help from a more experienced co-worker who has some success at meeting these productivity expectations. New employees, let alone new graduates, need more than 2 weeks to find the most efficient way to do their job. Though it sounds like the others you work with might not have the time.

    It sounds like this is less about your employer asking you to break the law and more about you learning how to be efficient. The manager is a jerk by not giving you the training or time to adapt. Re-evaluate in 6 months.

    1. KellyK*

      Eric, it doesn’t sound like the OP has coworkers who are successful at meeting the productivity requirements without billing for tasks they aren’t supposed to bill for.

      Certainly, it might be worth asking for advice from people who are hitting those marks, but a lot of that advice might come down to deciding between billing fraud and working off the clock (both of which you can get fired for). If you see anybody who meets their targets without bending the rules, definitely ask for their advice.

      I would avoid doing anything illegal and would ask my boss for tips on maximizing my productivity. They might not have any ideas for you, or might say “just work faster,” or they might hint that you should be working off the clock. But, they might have something useful, and you don’t know until you ask.

      Even getting something monumentally unhelpful is useful in the sense that it gives you more information about the job environment you’re in. (That is, are you really expected to do shady things, or are they just expecting a much higher rate of productivity than you’re used to.)

      I would also document, away from work, everything you’ve told us and any instance where you’re explicitly or implicitly directed to do something you aren’t supposed to. Primarily because if you get fired for “low productivity,” it’s likely to be useful if unemployment is challenged.

      1. ChristineH*

        I would avoid doing anything illegal and would ask my boss for tips on maximizing my productivity. They might not have any ideas for you, or might say “just work faster,” or they might hint that you should be working off the clock. But, they might have something useful, and you don’t know until you ask.

        +1 for this part

    2. Anonymous*

      It looks like the other therapists are meeting the unreasonable expectations set upon them by breaking the law, though, and it looks like the management is either encouraging it or is so harsh that this is the therapists’ only way to meet the requirements that will keep their jobs.

  2. Kat M*

    Ugh, when I graduated from massage therapy school, I briefly worked in a PT clinic where this sort of thing would go on. They wanted me to bill a full unit for a woman I only worked with for two minutes (she had an allergic reaction to the lotion used). They also wanted me to change my CPT codes to something that was easier to bill than just manual therapy. NOT gonna happen.

    I came into work one day and discovered all our patient files were gone; the owner and the referring doc were under investigation for insurance fraud. I mailed in my key and never went back.

    If I were you, I’d pick up some on-the-side PRN work now, so you don’t end up with too much of a resume gap if you decide you want to pretend this job never happened. Also start searching for a new position ASAP. Not everybody in rehab is so money-focused and out-of-touch with reality, but some definitely are.

    1. Josh S*

      Step 1 should be looking for a new job. Right now. You can’t work in an environment that crosses your ethical/moral boundaries (let alone the legal implications).

      Step 2 should be figuring out how to squeeze every bit of efficiency out of your time that you can. It might be hard, but show that you’re making the effort.

      If you are worried about what will happen if you get fired (or if you quit after such a short stint), realize that most other people you run into in your field will likely recognize the crappy employer. And you can always bring it up in an interview situation saying something along the lines of, “I was fired for refusing to engage in illegal insurance/Medicare fraud” and leave it at that.

      I don’t imagine this is a route you’re looking to take because of the time, effort, stress, and money involved, BUT you could contact a lawyer and look into filing a whistleblower complaint against the employer for Medicare fraud. I think the government is pretty high on rooting out fraud these days, what with health care reform, etc and the push to reduce costs. So you might find that worth your time (but I suspect not if it’s smallish violations). I dunno.

      Stick to your guns, but work as hard as you can. Good luck.

        1. Grace*

          Document it. It sounds like they’re committing insurance fraud. Trust me, insurance companies are very protective of their money. I’ve worked in law. I can think of several cases in my city of people who are sitting in prison for insurance fraud.

  3. Josh S*

    Alison, you really need to console yourself over your foot issues with some mango sticky rice. Seriously. Get better!

  4. Your Mileage May Vary*

    I worked for a psychologist for a few years and if he had a question about what was appropriate in the office, he would call the APA-provided lawyers and ask them. He had to pay a small amount for the lawyer’s time but it was completely confidential through attorney-client privilege.

    Does your licensing board have a service like that you could call and ask? I’m not a lawyer but, I would think that you could include the time you take to transport the patients to the therapy room and to disinfect afterwards. You may have to bill them as separate transaction codes that would be paid at a different rate.

    Also, in counseling, you bill for a unit which is considered an hour. But it’s customary in (counseling) therapy to only be face-to-face with the patient for 50 minutes and use the other 10 minutes to document the session, essentially at the POS time but the client is not sitting there listening to you dictate. You could ask if that’s what you should be doing in your line of work.

    But if you check out it all out and your employer is asking you to do something that isn’t legal (I mean actually illegal, not just you think it’s not fair to ask Medicare to pay) then you have a couple of choices:

    1. You could just quit.
    2. You could bring it up with your supervisor in a way that lays out the time it takes you to do everything that isn’t legally billable and point out what percentage of your 40 hours a week (or however long you work) that is. Ask if there is something she prefers you to do instead.
    3. You could make a report to Medicare, citing Medicare fraud. It would be confidential and they would audit the billing. Of course, at the end of the day, you may be out of a job because they may find enough billing errors that have to be repaid to cause your company to go bankrupt (I saw this happen to another counseling center).
    4. You could decide to stay and adjust your thinking to your supervisor’s.

    The problem I see with ethics is that everyone has their own threshold as to what is right and what crosses the line. It’s easy to be “ethical” when you’re just out of school and have had countless classes in ethics but it’s different in the job world – there are many shades of “right” out there. If it were me, I’d go with Option Two above after I had talked to people in my licensing organization. And if, after it was brought to her attention, my supervisor told me to suck it up and break the law, I’d do both Option One and Three.

    1. Jamie*

      “1. You could just quit.”

      NO – do NOT quit!! If they want to fire you, let them fire you…and then they will have to explain their “creative” timekeeping to the labor board when you file for UI.

      Quitting is the best thing you can do for them – don’t.

    2. sdhr*

      I like this advice… find out exactly what is and isn’t legal. I am reminded of when I was an admin and one of my co-workers was upset because her boss owed her about $100. When I asked for details, I discovered that her boss often had her run out to get coffee/danish for meetings and never reimbursed her. Her boss expected her to submit an expense report to the office maanger to get paid out of petty cash.

      The admin didn’t understand the rules and was sadly too intimidated to ask what the rules were.

      OP – ask about the rules so you know for sure. This 50 minute hour sounds familiar to me….

    3. Kat M*

      This is true. A billable unit for the OP is probably 15 minutes, but if the final unit is at least 8 minutes it still counts, leaving another 7 for prep.

    4. Lanon*

      “It’s easy to be “ethical” when you’re just out of school and have had countless classes in ethics but it’s different in the job world – there are many shades of “right” out there.”

      This. I think it would be smart to CYA, document and be careful because you’re in a medical field, as people below have suggested.

      But (and I don’t mean this condescendingly at all), I think it would be very wise to make sure you’re correctly interpreting the billing procedures and how the law works, since you’re so very new to the field, *before* blowing the whistle or quitting. Since professors aren’t always practitioners, they sometimes convey unrealistic or inaccurate expectations of real-world experience–sometimes because they’ve personally never had any real-world experience. I wish I had known this when I got my first job out of school. Instead I caused a big fuss and quit over practices that, unbeknownst to me at the time, are present at most places in the field and are just a regular aspect of the job.

      Asking your colleagues, supervisor, a mentor outside of this clinic, or your professional organization are great ideas.

      1. HR Gorilla*

        Chiming in to agree with this, as well. I was over the recruiting team at a previous employer, and one of the team members was a recent grad who had majored in HR. She would come to my office daily, insisting that we were “unethical” because we didn’t tell each rejected candidate why s/he hadn’t gotten the job. After several times of explaining that we were a private company and weren’t legally required to do so, and that our resources prevented us from being able to do so, I think she began to understand.

        I was/am a huge advocate of taking good care of your candidates–even if you end up not hiring them–but providing each candidate with the reasons for not hiring them (and then dealing with the subsequent follow-up calls/emails to discuss those reasons) often simply isn’t possible. Once this particular grad had a couple months’ recruiting experience, the “ethics” of whether or not we informed each candidate of our reason for not hiring them became a completely moot point for her.

        Buuut: that’s hr, not the medical field, and in the above situation, I was very sure of the legal standing of our recruiting practices. I agree with several of the other posters: make it obvious that you’re doing everything you can to be as efficient as possible with your time, and find out whether you’re actually mis-billing some items, and then re-assess after a reasonable period of time.

  5. Blinx*

    Stick to your guns and only do what you believe to be ethical/moral/legal. Document everything. Let them fire you. Hopefully you can collect unemployment compensation.

    In your new job search, you will now have a whole host of questions to ask at your interview, regarding billing, turnover, performance expectations, and allocation of duties. And if you are ever asked in the future about how you would handle a difficult or potentially illegal request, you’ll have a great example.

    1. Anonymous*

      I beg to differ. The OP really should find out what is legal, not what they “think” is legal. For all we know, it could be that Medicare considers that to be standard practice.

  6. Jamie*

    The problem is both management and the co-workers, imo.

    If, when the aides were let go, the co-workers refused to pad the bill time or work off the clock then no one would be hitting those marks.

    The first rule of metrics is that if no-one can meet them the problem isn’t the people – it’s the standards.

    But because they do this management can hide behind “well everyone else is able to meet the numbers.”

    I understand the rock and hard place for them – but from an outsiders perspective this has a ridiculously easy fix. Everyone follow the rules, as written, and they will change the metrics.

    But they probably won’t do that – because people are (understandably) worried about their immediate job security and not the greater good.

    Does your agency have it set up for anonymous whistle blowing? I would have to be very secure in how seriously they take the anonymous part – though.

    1. A Bug!*

      While it is true that the coworkers technically have a part in it, I would be reluctant to assign much blame to them for contributing to the issue. When the choice is “sticking to your principles” or “putting food on the table and a roof over your head”, sometimes the answer’s not all that clear.

      The employer put the employees in an untenable position. From the letter, I get the impression that the employer has not exactly created an environment where the employees feel comfortable telling the employer about their obstacles to success, so to speak.

      Yes, perhaps the employer would learn a lesson if everybody worked to rule. The employer can’t fire everybody, after all! But the employer sure can fire one or two, and who wants to risk being made an example of in an economy like this?

      1. Jamie*

        I agree with everything you said – that’s what makes it to frustrating to know it could all be resolved by everyone banding together – but for understandable reasons they don’t.

        I’m not justifying the compliance with shady practices (if that’s what’s happening) just saying that if everyone stuck together and worked according to the laws and the policies then it would be clear whether the goals were attainable or not.

        But you’re right – it takes a lot of courage to be the one to make a stand and go all “is everybody with me!” at work…because if they aren’t you’re neck is on the chopping block by itself.

        In a perfect world this would be a non-issue. I really need to find that perfect world I keep talking about…one of these days…

    2. Joy*

      I would NOT suggest whistle-blowing, even anonymously, until OP is sure there is something illegal going on. I am in the medical field and agree with other comments that her peers may be practicing perfectly legally and ethically; she hasn’t had enough exposure to know what is acceptable and what isn’t. I do think her boss should explain these things to her in a way that makes her feel comfortable.

      I remember being very uncomfortable documenting certain things early in my career and would argue with my manager about what she wanted me to chart because I felt like it was fraudulent. She got tired of trying to convince me and connected me with someone from Medicare who explained to me (in a way that I was satisfied with) what the purpose was and that it was appropriate.

  7. some1*

    As far as making a complaint, you could try your Atty General’s Office or State Dept of Labor. The Atty General in my state goes after employers who pull this kind of thing.

  8. bemo12*

    My fiance worked in a PT clinic like this where “creative” billing was not only encouraged, but the Physiatrist would often stay late and change records unbeknownst to the therapists.

    She was found out and fined an astronomical amount and almost had her license revoked. The therapists were also in hot water, even though they were doing things legally.

    Get a new job quickly, it’s not worth risking your license for this place.

  9. Carl*

    Dear OP,

    Stick with your integrity. No boss is worth throwing away your self-respect; period. I’m certain there are ways to anonymously report that your employer, and the employees, are doing things they legally are not allowed to do. “Bending the rules” is still breaking them, especially in the medical field (this is why doctors charge so much — all that malpractice stuff).

    If you think this is such a small industry, don’t you think there would be others in your position? I would say so; your current coworkers are in it. I think you’ll have plenty of sympathy along the way, and the fear that someone won’t hire you because they think you’re a rat or something may be unfounded. I’ve met plenty of people in the hospitality / care biz (doctors, social workers, therapists), and the story is common, and exists in lots of industries.

    If you’ve been upfront with your boss and coworkers about this, you have leverage; that is, if you report it (anonymously or not), there is evidence that you tried to remedy it, and that others just let it continue. When it comes to investigation, I’ll put this in a metaphor, the more chickens there are, the easier it is to catch one. (Probably not the best metaphor, but I think you get the idea that it gives investigators more evidence to help stop something illegal.)

    If you haven’t been upfront about this with your boss, explain it to them. If they fire you, well, now you got more leverage than if you weren’t fired.

    As I stated at the beginning, don’t lose your integrity. Nothing’s worse than walking around in life with little to no self-respect. You’ll always be with you, employed or not.

  10. Satia*

    OP, You might want to research what the possible penalties are for filing false Medicare claims. Upcoding/unbundling/etc. are all considered forms of fraud and is considered a federal offense. Bear in mind, whether you are told to do it by a manager or not does not absolve you from your actions and you can and will be charged, perhaps lose your license, serve time in prison, etc. I realize it can be difficult to walk away from a job when you need income but how much can you make from behind bars?

    Say no. If they fire you, collect what unemployment you can while looking for your next position. If they do not fire you then you haven’t lost anything and, when they are audited (which surely and eventually they will be), the audit will not turn up anything peculiar in any of your documentation.

  11. Theresa*

    You need to report this, it is illegal (Medicare, for heaven’s sake!), and if it is found out later that cheating was going on, you and the others in that organization could be hurt (badly). Remember Enron and WorldCom. This employer is unscrupulous suggesting (whether directly or indirectly) that you bill for unbillable tasks. Don’t do it! Keep your integrity, no job is worth it. And turn that SOB in so they won’t continue to do it. I don’t mean to sound preachy, but ethics begins with you, not somebody later on down the line, especially in the medical field.

  12. KT*

    I don’t know what state you are in, but do you have a licensing body? Even if what your clinic is doing isn’t illegal but more of a gray area, they could end up in hot water or losing any licenses/certifications. If you participate, you are also putting yourself at risk for losing your license/certification.
    I would contact your licensing body to clarify what you are and aren’t allowed to do, and stick within legal means.
    If your employers pressure you, say I checked with the “Florida Board of Occupational Therapy” (or wherever you are) and they said this practice is illegal. I can’t afford to lose my OPT license. Presumbably, neither can they!

    1. littlemoose*

      I second this. I recommend getting in touch with your licensing body and getting their input. They may be able to give you guidance as to what needs to be reported, etc. I agree that, based on what you’ve said here, it sounds like possible Medicare/Medicaid fraud, and the government is not joking around with that. Document everything (and keep the documentation away from work, in case you got fired and could no longer access it to CYA), look for a new job ASAP, and get your professional licensing board’s input. You could also look to a national organization of OTs for input and/or guidance; I imagine they have some good resources online for you to check out. Good luck!

      And finally, working off the clock is not legal, as many others pointed out. If your conversations with the management at this job strongly imply or outright say that you should be working after you’re clocked out to meet your productivity goals, then document that too.

  13. A Teacher*

    As an athletic trainer, with a medical license, you are risking having your license suspended and a HUGE fine if not jail time. I worked with a PT clinic that did this. They wanted me to co-sign on Medicare treatments, didn’t work one-on-one with Medicare like they were supposed to and tried to go above billable units/bill for things that weren’t billable all the time.

    Leave now. If they are already doing this it doesn’t get better. You may be asked to co-sign for PT stuff that you aren’t treating so that they can stay legal. If you are forced to stay, document EVERYTHING (underlined and bolded), basically CYA. It is NOT worth risking your license and your profession to stay.

    1. A Teacher*

      Chances are also good that they aren’t billing other insurances appropriately. It only takes one audit and you are not only out of a job but out of a profession–watched it happen to a clinic director, he’s the one they through under the bus to save themselves.

  14. Brandy*

    Don’t do it! Don’t do it! Don’t do it!

    Okay, I just had to say that. Please, don’t do anything you know is illegal. Medicare is a horrible beast (speaking from someone who used to do medical billing) and can absolutely come down hard and fast if there is even a whiff of billing for something that was not actual patient care.

    Also, working off the clock is NEVER a good idea. What if a patient fell and you were called on to help her and while helping her you were hurt in the process? Yes, I know that won’t happen regularly, but I’m just using it as an example. If you are off the clock they can easily deny you worker’s compensation. You do NOT want that to happen.

    I know it’s not an easy job market out there (this is coming from someone who has worked in healthcare for years and is currently in school for a healthcare field) but you definitely do not want to work for a company that’s putting quotas above doing the right things. Absolutely start looking for another job while doing everything you can to do your job legally. It sounds like this is a company more worried about the bottom line than its employees. I’m sorry.

  15. K.A.T.*

    I’m a new grad too (nurse) and finally found my first job and I absolutely understand how hard it is to find work now. But reading this raised tons of red flags for me – you know you need to protect your license and be careful here! Don’t do anything that puts yourself in jeopardy and do consult any licensing or professional bodies you can, or report anonymously. And yes, document everything at a non-work location. And please keep looking for a new position. If they behave this un-ethically towards patients and Medicare they will do so to you as well, and you definitely can find a place that will treat you right!

    Just out of curiosity, is there any way to in fact document while you are treating? Portable computers or charts or anything? Because it sounds like you could then bill for the documentation time which could help with some short-term issues.

  16. Sara*

    I think you need documentation from Medicare or your industry’s professional standards board on billing and how it can and can’t legally be done. For example, as someone suggested above, if you bill Medicare in 15-minute increments and as long as you spend 8 minutes doing work on behalf of the patient, you can bill that increment, you can leave the last 7 minutes of that increment to disinfect, etc and do the work that aides used to do. That may be fine in the eyes of Medicare because you still spent 8 minutes with the patient. If it’s not allowed, you need to figure that out for sure and have documentation to show your employer.

    If you do find that time to do the aide work, in an 8-hour work day, that still leaves 72 additional minutes (15% of 8 hours) to do your other paperwork. That seems possible, although very difficult.

    If it does end up being impossible to do legally, take your documentation, and a breakdown of everything you have to do each day, minute by minute, and show it to your boss. Show them that at 85% productivity, you only have 72 minutes to do X list of required, non-billable tasks for X number of patients each day. Ask where they see your inefficiency and how you can make up the time. It will be very clear to you at that point whether your boss is asking you to do something illegal (bill something you’re not supposed to, work off the clock to get paperwork done) or if there is legitimate room for more efficiency in your day.

    1. SurlyHRGirl*

      “If it does end up being impossible to do legally, take your documentation, and a breakdown of everything you have to do each day, minute by minute, and show it to your boss. Show them that at 85% productivity, you only have 72 minutes to do X list of required, non-billable tasks for X number of patients each day. Ask where they see your inefficiency and how you can make up the time.”

      This, a thousand times this. I was thinking of posting something very similar, but this is better worded than I would have done. Often management is not “in the trenches,” so to speak, and so they don’t know what it’s like to be the person doing the work. Managers get pressure from higher up managers, their bosses, so the pressure often trickles downhill. If you present your problem to him in writing, perhaps he can help you solve it. If he can’t, at least you have documentation that you tried.

  17. Blue Dog*

    You should not do anything illegal. However, it is possible that they are not asking you to. Frankly, you are a new grad and you don’t have all that much experience in the field.

    It is possible that you are not be efficient. It is possible that you have not learned short cuts. It is possible that you are not capturing your time. It is possible that you could learn things from other people who have become more proficient at it.

    Or, it is possible that they are engaging in billing fraud. However, I wouldn’t be so quick to assume that if you are new to the industry and haven’t learned the ins-and-outs yet.

  18. A Teacher*

    Because she is a new grad, they probably are having her do things illegal. I saw it happen to many times when I worked for one of the larger PT companies. Yes, you can bill for 8 minutes but you are only supposed to have so many billable units (typically between 4-6 actual units) I’ve seen billing for 6 units (1 1/2 hours or so) when only 3 were done and only 4 of those units can be for hands on in one treatment (typically). Also, OTs and PTs are only supposed to be 1-to-1 for Medicare patients (the PTAs and OTAs they supervise can have a patient load at the same time so you’re co-signing legally) if they are having her treat multiple patients at the same time without a co-signer (i.e. PTA, OTA, ATC, or another PT/OT) then that is illegal too.

    Don’t get me started on work comp…don’t jeopardize your license for this company. It is too risky.

  19. Joey*

    I’m going to go against the grain here first by saying I think the post title is inaccurate. At best it’s implied that you should break the law but I think even that is a stretch. What I think the evidence really points to is that the expectations are probably just too high.

    I really doubt that management condones breaking the labor or Medicare related laws. What id recommend is bringing forth all of the concerns if you haven’t already done it. It helps if you can quantify the non billable tasks and the time it’s taking to complete them. If the expectations are indeed unrealistic you should ask your manager for guidance on how to handle the parts of your job that aren’t billable. If you believe they’re directing you to break the law it often helps to say something like ” I’m concerned because my interpretation of the law is….”

  20. Kris*

    I would go about this a little different than some of the others are saying. I would definetelly ask management for their suggestions. If those suggestions include insurance fruad or working without being paid then I would notify the correct people (Social Security/Labor Board) and start looking elsewhere.

  21. Lisa*

    You can often consult a lawyer for as little as $40-$50 for a half-hour consultation. It might be worth asking a legal expert before quitting your job or putting yourself in danger of being fired.

  22. Debbie Downer and the Negatrons*

    I’m suprised I haven’t seen this in the comments yet, but working off the clock is also very illegal. This is never a solution. As some other commenters have said, you need to address the issue head on with a supervisor and ask where you can improve your efficiency. Keep an ear out during this conversation for those clues that indicate if they really are asking the impossible and want you to practice illegal billing or time coding.

  23. snuck*

    In any industry there are work situations where people are over worked, unsupported and asked to do things that are a bit shady/outside industry regulations.

    It sounds like you’ve hit on one of these employers, so my advice is less OT specific (although as a past OTA I do understand a lot of what you are talking about) and more general to the wider employment situation.

    Know that if your employer has a history of this (which is sounds like he does) then others in the industry will know this – if it’s that small a world then probably several people you will come across have worked for or at least encountered others that have worked for this man. This means (to me) you an leave as soon as you find another job, and just explain in interviews why you are moving so soon with a positive attitude (something like “Oh my previous workplace was very pressured to meet targets that I felt were unachievable without an OTA”).

    In the mean time do not quit your job, same as for any industry – easier to find a job when you have a job. But do start job hunting quietly and see what else is out there. Networking might be the best opportunity for you, because it gives you a chance to talk informally with people about their workplaces before you consider applying – which will give you some insight into whether you want to work there. Swapping jobs frequently though isn’t a good idea.

    Do find a mentor or two amongst your colleagues – even if it’s just to have lunch with and ask them how they get it all done. Plan your days if you can so you are seeing appointments that make sense for minimum clean up between (and make sure you find the most efficient cleaning methods you can), and other efficiencies – ask whether people can be taken to the gym by other staff (ask your colleagues how they are handling this – I found certain nursing staff would do things for some staff but not others etc) or examine whether the activity needs to be done in the gym etc. I don’t see anything wrong with taking two minutes to write up a quick set of notes with the client (every medical professional does this) but agree that writing up longer referrals, detailed case plans etc probably need to be done at another time – and not knowing your Medicare system you’ll need to ask your industry body about when this can be billed.

    Many private practices will have paper work being done outside of hours/billing – find out if this (and other issues) are actually a factor of being in private practice rather than a flaw of your particular workplace. It doesn’t make it fair, or right, but if you are wanting something different then you might have to find out where in your industry that difference is available. And many private practices offset their expectations of billable hours or ‘take home work’ etc by paying higher than public service.

  24. Erik Hammarlund*

    As an employment lawyer, I’ll comment that you are spot-on regarding the illegality. Don’t do anything illegal.

    It can be helpful to distinguish between things which are illegal acts on the part of employers (e.g. forcing you to work extra hours for no pay) versus illegal acts on the part of employees (e.g filing known-false Medicare reimbursement forms.) The second category is far more dangerous.

    On that subject, I will also note that you may in theory be able to bring what is referred to as a “qui tam” action. This essentially involves reporting your employer to the government, so that the government can recoup the money (Medicare padding) which was stolen from it. These can actually be fairly valuable suits, as the reporter will generally get 15-30% of the total recovery.

    I suggest that you talk to an employment specialist, and see what your options are.

  25. anon-2*

    Don’t ever break the law. EVER.

    First of all, “but I was just following orders” has never been an effective defense when / if you’re caught breaking the law.

    Second – remember – if you’re involved in doing something wrong, and the plan breaks down, the law of the street (and jungle) applies, and it’s “it’s every man for himself.”

    Third – don’t even expect corporate counsel to back you or smooth things out. HR, counsel, etc., are only concerned with protecting the company, and not YOU.

    I would do as Eric states – contact an employment specialist, and find out what to do next. Remember – your future could be in jeopardy. You can always find another job, but once you’re tainted with corruption, you won’t.

    1. anon-2*

      What I meant by “every man for himself” — if the company gets caught – YOU will be blamed if you can be held accountable.

      In one place that I worked – I was sometimes asked to break copyright provisions — illegally photocopying manuals, and I refused. A funny thing always happened — whenever I was asked to do something like that, the instruction was verbal, and **I** had to put **MY** name on the request.

      When I said “that’s illegal, if you want to do that, YOU sign it.”

      Uh… uh… uh….

  26. Bostongirl*

    Welcome to the world of cut-throat competition. It’s horrible what companies are expecting. I graduated in 2010 and still do not have time to go to the bathroom or take a breath during the day because of productivity. Illegal and unethical decisions are contantly being made, and I refuse to be a part of it. People working in snf’s are not going to last because its unethical and employees are treated like they are on conveyor belts. I am going to be leaving this seeting this coming month due to everything. It’s just horrible, and now these companies want to make the same amount of money that they did before the Medicare cuts. I believe Medicare should cut more. Patients are kept on WAYYYY too long. I’ve had it and it’s taken a toll on me. Even tho the setting pays well, I’m not happy and will take a lesser pay to be happy in another setting. My advice would be to stick to your guns and don’t let anyone push you to do something unethical and illegal. It’s YOUR license on the line, not theirs. Ask them to do it if they keep pushng you and you have the same licenses. All you have to say is that you don’t feel comfortable, the patient has reached baseline, and if they feel they can progress the patient further than you won’t be upset if they become the primary therapist for that patient. Good luck!

  27. same boat*

    Hi- how did things work out? I hope ok..I am in the same boat as you..well similar. After a year of being hassled and threatened for productivity, I got the boot today- my “%” is just about 6 below avg and just 3% below the “company norm” which is less than the company expectation. Sad as I’ve devoted so much to this group. I worked w/this population for over 10 years and I loathe how the business model has taken over the care of our elderly folks. I am hoping my next job will be truly patient-focused where I can do my best each day w/o fear of being fired. And sick of all the off the clock hours I’ve done to document and write up evals. Sigh.

  28. NiteOwl*

    Medicare does allow for set-up time in regard to the disinfecting.
    However, since this post was 2012 the NEW requirements for productivity are 90% for all travelers and companies such as
    rehab care. If you do not reach the productivity there will be disciplinary action. This is the new trend. Will honesty feed you?
    It may not feed you or pay your bills but it will keep you out of jail.
    Eventually, if enough therapists come forward there will be change…but as long as people are afraid of becoming homeless (and you still have to repay those school loans regardless) then companies will dictate what we MUST bill if we are to keep our jobs. It is NOT about efficiency or time management either. Younger therapists can move faster but are also more likely to cave. Difficult or very sick or very old patients just don’t move fast enough for 90%. DOJ did not care. I already spoke with them. Better to take it to the FBI tip line because in rehab services it is harder to pin down dishonest billing practices. You MUST be able to prove that they were forcing you to do something illegal…how can we do that when there is no way to prove just how much productivity we are capable of providing? I GET 90% some days…in 2014 I am also without a job now.
    Remember, it is supposed to be about the patients and helping people get better. Do what is right. Good Luck

  29. Lorna*

    I will say this DO NOT BREAK THE LAW! I work for a therapy company based out of FL but they are also in MA AND PA. Medicare is crawling all over them and to save their skin they are firing entire teams. However truth be known this new company encouraged over billing, false documentation, and even the sickening billing without even seeing the patient at all. I witnessed it! An employer can only force you to clock out for lunch. It is your right by law you can take bathroom breaks, take emergency non related phone calls just to name a few. Now if your company requires you to clean equipment, transport patients, it is unlawful for them to assume you are just clocking out to do that. I advise you file a complain with your states dept of labor. Also it is illegal to sign out and do your documentation. Our company required 95% which left 15inutes to write progress notes and none were point of service because there was only one computer for 6 therapists. For legal reasons I will not name this company but they took the aegis contracts. Horrible, fraudulent, and only want ultra high categories even on 104 year old patients that are dying. Clearly nobody was getting those minutes but they all billed they did because of the pressure from DOR and the powers that be. I’ve reported it all and will watch the news closely. They are bilking millions out of the tax payer. My conscious is clear! Also I needed to report it directly to Medicare because the companies fraud tip line was a joke.

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