It is a covered service if there is not willing or able caregiver and the ALF is not licensed to administer injections. (Ours aren't).
Don't think of it as fraudulent, it is not at all lucrative for traditional Medicare and Medicare Replacement Plan patients. (I don't know if fee for service commercial plans cover daily visits, it's never come up for us). Our wage reimbursement for the SN alone would be $3,900 for long term daily visits. Recert your patient and then ask your agency what's the Medicare reimbursement for this patient.
40.1.3 - Intermittent Skilled Nursing Care
(Rev. 208, Issued: 04-22-15, Effective: 01-01-15, Implementation: 05-11-15)
The law, at §1861(m) of the Act defines intermittent, for the purposes of §§1814(a)(2)and 1835(a)(2)(A), as skilled nursing care that is either provided or needed on fewer than7 days each week, or less than 8 hours each day for periods of 21 days or less (withextensions in exceptional circumstances when the need for additional care is finite andpredictable.)
To meet the requirement for "intermittent" skilled nursing care, a patient must have amedically predictable recurring need for skilled nursing services. In most instances, thisdefinition will be met if a patient requires a skilled nursing service at least once every 60days. The exception to the intermittent requirement is daily skilled nursing services fordiabetics unable to administer their insulin (when there is no able and willing caregiver).