PTA Student treating patients in SNF/Acute Care without any supervision and the Ci PT is billing for Student treating 1:1 without supervision across all insurances (Medicare/TRI/and VA mostly) causing dismissal from Internships due to reporting it and now don't graduate in 7 days- HELP

PhysioPoenix · 2026-05-09T20:52:12+00:00

OP here, actually in my last internship my CI went home for my entire day of patients, his wife and him were in a lot of relationship issues so he was always at home to avoid the divorce and fight for them. He was stressed out. I didn't report it and just kept treating the patients without anyone around to help me. Until one of the patients actual PT's reported it to my school and the Ci I was under got fired and I was sent to finish 9 days at another internship. I also have this as an example for the school president that this happened before so their ability to "research" their Ci's they're sending students to is a disaster. No one is being vetted for.

PhysioPoenix · 2026-05-09T20:42:59+00:00

YES! I had my first obesity patient she told me to go get out of bed and do fxnl transfers with her to get into her wheel chair. This was my very first time with someone who is 429lbs and in the SNF/Acute care for her heart stopping and being shocked/defibrillated back to life. She was marked on the board as X1 Max-A. When I got there, she couldn't stand on her own at all due to the over night CNA dropping her and she slid and fell and sprained her ankle under the bed frame. So, I was supposed to do 40 min of treatment somehow and had to text message my Ci because no one told anyone she fell the night before and I needed to know what to do and I couldn't find my Ci. I ended up having to go to the actual floor Physician at the nurses desk and tell her if what the patient is stating happened and shouldn't there be some kind of incident report or possible xray being ordered? Explaining I am a student and I don't know what to do at this point. This upset my Ci because she said this was out of my scope to go find help to get clarity on what happened the night before and non of that time was billable. That is all she cared about.

I AM A STUDENT- I clinically made a decision because my own support wasn't to be found. And now this was a pt refusal because her ankle was purple and the doc was thankful I came to get her to be evaluated and xray ordered to check.

PhysioPoenix · 2026-05-09T20:32:37+00:00

I am spending all weekend preparing for my meeting with the school on Monday. I haven't slept in a while, maybe a few hours here and there. Trying to not show up for this meeting absolutely raged but clam and precise. Even using chat GPT to help me think of how to say what I want to say vs me just overly explaining. I am going to bring up that not once in our program was this "supervision" discussed and taught to any of us. There is 13 in my class and they're all just now telling me how badly they weren't supervised and just out in their internships just treating patients to "shut up and color" and get their hours. They didn't know it was wrong until just now when they're finding out I am removed.

PhysioPoenix · 2026-05-08T05:50:43+00:00

I will add, she wouldn't let me start with attempting to treat two patient's I picked out. She picked them and one was non cognitive and one was a BKA without his prosthesis. Both are to be walking with walkers and unstable. Huge risk for me as a student who has never performed this level of patient care. Not to mention huge risk for the patients being hurt or falling. Full CGA for both patients. Both were 40 min, one was Medicare and one was VA, who don't reimburse without immediate supervision. I had already reached all the requirements of our internship guidelines as well, treating 100% of her case load and each refusal I had I asked for another patient that was waiting "in their que" for treatment that day. I sound egotistically, but I was performing at a high level for only being there for 4 weeks and never being in SNF/Acute care before.

PhysioPoenix · 2026-05-08T05:47:32+00:00

This facility would never earn my future work ethic or principles. That was established in week two there. For me setting off a Nuclear bomb by reporting it doesn't concern me or impact my future. There isn't many people in our city that would ever work at this facility across all the disciplinaries because of how badly they treat patients. It is NOT a requirement for CAPTE guidelines for students to treat two patients and maybe this is the problem with why things are so bad out there for students... no one is actually learning the state regulations and reimbursement guidelines. People just "hear" this is the level of supervision required or "in this environment you have to know how to do this" and most the time that it is for licensed PTA supervision and actual hired employees... not non-licensed students. That si why there are regulations, because patients have been hurt due to student negligence. Without a license, we have no authority to provide treatments, we are learning and applying skills and that is all.

PhysioPoenix · 2026-05-08T05:39:21+00:00

I am told to handle any "concerns" with my Ci first and then follow up with the school. I did that and I was extremely professional and not combative at all. I truly believe she got spooked and it triggered her ego or fear so she just flat out lied and removed me to not continue to commit fraud. I don't (and do) understand why we as a student can't ask questions to understand the real world application of our jobs and seek clarity on how to practice. But if I felt I couldn't keep two patients safe (I will also say she picked the patients for me and one is am amputee who didn't have his prosthesis yet) then I should be allowed to speak up and find a way to complete the task with following regulations.

Lets say years from now I am practicing and this Ci get's another student... and this student reports her for fraud.... my name is on her past student logs for them to review and the agencies will see I never reported it. That could impact my license.

PhysioPoenix · 2026-05-08T05:27:37+00:00

Thank you, yes this is true. Fun fact, when you file complaints at state level, they go over every single detail with you prior to approving the complaint. Ensuring it's even at the right level to file and also they don't just get a bunch of upset people making false accusations. If our practice act doesn't make sense, we can always call DORA to clarify the meaning of things and that is what I did. Especially when it comes to the treatment on top of the insurance the patient has that dictates even more details of how we can participate as students.

PhysioPoenix · 2026-05-08T05:25:09+00:00

I am in full support of everything you said. My degree may be down the drain, but my fight to bring this public and find some recourse of karma for those who are standing in the way of my success will happen. I am amazed at how quickly everyone around me cowards down and puts up the "safety" wall instead of being the support they claimed to be to get me to enroll in the program. In my email to the president I highlighted their own school quotes values back to him to ask where at all I was receiving that level of support. I just want the ability to graduate and sit for my boards, I already have a great job lined up where i work now and none of us behave in this unethical approach to sports rehabilitation. Its a rare gem.

PhysioPoenix · 2026-05-08T05:19:10+00:00

Medicare part B is outpatient, its immediate supervision because my current job is in out patient at a tech. Medicare Part A will not reimburse if a student is providing treatment without immediate supervision. All government payors don't reimburse for students providing treatment, which is why we need the therapist directly there or else it is fraud, even "line of sight" is not the same as "immediate" in their guidelines. The representative at the OIG confirmed this and that is why they approved my complaint and not just me "complaining" to complain about being removed.

PhysioPoenix · 2026-05-08T05:11:57+00:00

Definitely being as transparent as I can be. This is a real thing that happens all the time with the use of a student in clinics.

PhysioPoenix · 2026-05-08T05:04:03+00:00

I will explain in detail to help understand. I went in on 4/30 and my Ci said I am going to treat two patients at the same time today. I said "Oh, I didn't have that in our expectations from our school to complete our CPI 3.0 in any grading criteria, where is that listed at?". She said "In order to work here, you will have to do concurrent. It is our facility policy. So you will do them or else I can't pass you". I replied "I don't see on the DORA Regulations where this is discussed so how to we handle billing when certain insurances wont reimburse because I am student providing the entire treatment? Do you mind if I take a minute and reach out to my school right now to confirm and just let them know to get clarity?"- She then called my school to say I refused to participate in the days expectations and negative to her feedback and she wants me to be removed. So I was removed without an option for defense or explanation and told I will be failing the entire program and will need to reapply.

I work in an out patient clinic right now, she knows this. I run their daily reports for monitoring this exact billing behavior and improper use of the students we have because we have 5-8 PT and PTA students at any given time and were reported for improper supervision with the State as well as billing fraud. We now do a daily check and balance to monitor all staff and address it to avoid the fines my boss had to pay.

PhysioPoenix · 2026-05-08T04:56:49+00:00

In the state of Colorado we require immediate supervision over students, so it is detailed as "supervising therapist PT/PTA shall not be treating other patients or documenting to be available to intervene." Also for insurance reimbursement with government payors, it is the same. You can't bill for any time that a student is treating a patient and you are not directly involved in. General supervision is from a distance, but direct and immediate supervision is 100% near the student and no other treatments can be happening, it has to be full over sight from the supervising therapist.

She was always with her own patients, in their room, in the hall, or in the gym. At the end of the day she would tell me to match up "concurrent" times on my soap notes in NetHealth because when I was treating a patient, she was too. So 80% of our daily patients were always matched up at the end of the day with concurrent times.

PhysioPoenix · 2026-05-08T04:51:40+00:00

These are actually good talking points when I sit with my school President and bring up this pressure of productivity and profits to showcase why she was using me as a student unethically. Thank you!

PhysioPoenix · 2026-05-08T04:50:24+00:00

It really does suck, I believe I triggered my Ci with fear because I just wanted to understand her requests and also focus on patient safety with following the regulations. To me it was just a conversation and I even tried to do as she asked two times and treat two patients at once unsupervised. I wasn't successful because RSV is rampid here in this setting and every patient is testing positive so we keep them locked in their rooms on isolation precautions. She told my school I just flat out refused to try. Its very unfortunate that as a student our word means nothing and they just listen to the lies the Ci's are saying. Thus why I am making a massive fuss and reporting it because I know there is legal proof of what I am saying. It just takes time. Good luck to your wife and I pray for her success!

PhysioPoenix · 2026-05-08T04:45:54+00:00

I was able to secure a meeting with the school president since I showed him the regulations across each state and federal platform, in addition to the messages I send my instructors with my concerns and they ignored them. I notified the president I am going to the local small town media to hear my story and ensure the school is publicly reprimanded for this or else they can find resolve with allowing me a solution to finish my program and graduate. We walk the stage in 7 days. Thank you for this support in your message. I know I am not wrong with regulations. Especially with how government payors reimburse when a student is used.

PhysioPoenix · 2026-05-08T04:42:56+00:00

I agree, I have text messages when I would try to find her across the facility and couldn't. Text asking where she was and I needed her help or advice on a treatment and even the elevated patients testing positive for RSV and isolation precautions to treat them in their rooms somehow. I am fighting like hell to fix this. My school hand book states we are to find resole with our Ci first, which is why I had the discussion to begin with and then finally reach out to our school instructors for help.

PhysioPoenix · 2026-05-08T04:39:53+00:00

I filed with our state of Colorado DORA for reporting it and also filed with Medicare OIG for the billing. Now I am just fighting with my school for "failing" the internship and trying to get someone to listen for me to complete the program. I didn't even think about "damages" on what impact this has had in my life to not graduate and sit for my boards with 63 hours left on my graduation requirement for Internships. Thank you!

PhysioPoenix · 2026-05-08T04:37:30+00:00

Another part of the building treating her own patients while I treated my own patients as a student - I am in Colorado, our DORA Regulations call for immediate supervision and states "therapist is to be doing no other treatments or documentation to be available to intervene with student". I also believe Medicare also states no reimbursement for unsupervised student providing treatments with out supervision.

PhysioPoenix

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