If the patient isn't progressing in the SNF or PT, after 30 days is there a issue with Medicare in this instance?

You only become a long-term if you need more care than ur family can provide. There is rehab where ur there just for that. If patient not improving then therapy is fudging records for Medicare to pay.

Once the patient is no longer doing PT they are a "long term care" patient status so you pay out of pocket until the money is all gone and then go on Medicaid.

Medicare will not pay for therapy if the person shows no improvement. You should have had conferences about how the person has been doing. Medicare pays for the first 20 days in full. After that, half. Need to talk to the therapist in charge.