See related article: Stratford Doctor to Pay $700K for Alleged Nursing Home Scheme
Dr. Ralabate has an exemplary record of providing excellent care for all of his patients. He has never provided inappropriate or insufficient services. Because Dr. Ralabate always takes his patients' welfare as his primary concern, he believes he has greatly reduced his patients' suffering as well as hospital readmissions, saving money for his patients and the Government. Because of his excellent service, the skilled nursing facility's CMS rating under his care went from a 2 to a 5, which is the maximum rating such a facility can obtain.
Prior detailed audits by CMS proved that only 2 out of 54 procedures/services studied were coded higher than the documentation supported and only 1 was thought to be for more services than necessary, while 14 were actually under-coded. Even though he provided more services than his peers, 98.2 percent of the services studied extensively were found to be medically necessary. This prior audit actually resulted in increased payments to Dr. Ralabate.
Dr. Ralabate had an excellent administrative record. It was only when he later learned that the excellent level of care he provides to all his patients was found in a later audit to be beyond what Medicare pays for that he chose to settle the case -- rather than take time away from his patients and pay legal bills for a trial. This was a hard decision, because he learned during the Government's review that even investigators said they would love to have their parents receive the better than the customary care he provides.
The Government alleged that Dr. Ralabate billed for nursing home services while patients were in the hospital. Dr. Ralabate did in fact visit and provide his services to his nursing home patients in the hospital as part of his commitment to excellent and continuous care for his nursing home patients and he never billed for services that were not provided. The financial settlement was only based upon the Government's belief that some health services were miscoded, or provided more care than Medicare would pay for. He chose to hire billing and coding experts to prevent any risk of noncompliance and assure no future questions, and continue his exemplary care for his patients.