>>OK, so we agree on that target.

Perhaps you can accept that I have some knowledge of the OCR and RAC audits. Consulting rooms full of Medicare toenail-clip patients is an audit magnet if you consider the outlier coding that results. Recovery Audit Contractor (RAC) auditors are paid on a contingency fee basis and are eager to recover funds and claim their share. Only a particularly foolish physician will draw attention to themselves by making frequent questionable claims in an area Medicare says generally is not covered. Those auditors do not eat unless they find $ to claw back, so they are relentless.

>>Next, I'd go after the rehab mills who perform exactly the number of days and modes of rehab that Medicare will pay.

Would you also go after the car mechanic who advocates service plans and intervals exactly as per manufacturer spec? Those Medicare intervals are not arbitrary, they're based on a version of best practice that makes it difficult to criticize practitioners who try to comply.

>>When my wife was going thru that nonsense - she couldn't walk or eat - she was on a feeding tube and barely could recognize me. They wanted to give her speech therapy because Medicare would pay for it.

Bill, sorry to hear about your wife and not wanting to comment on specifically- but speech therapists also provide swallowing assessment and therapy such as might be helpful for somebody on a feeding tube, especially if it causes distress. Also consider that healthcare workers often are driven by a desire to assist that sometimes with the best of intentions crosses from prolonging life to postponing death, or providers looking for some service- any service- that can be offered in sympathy to somebody who is in distress. It may well be appropriate to confront trainees with this so they can see it in themselves and offer a few kind minutes of listening and gentle laying on of hands rather than pinging of signals from machines and a barrage of annoyingly cheerful but hopeless therapy attempts.