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Yep. Let's not forget that there are some bad actors among us, and they make things worse for the rest of us.They practice in a way that creates a market for PA
Places like Genesis and before them 21c are almost too big to care. (I know I perseverate on scale, but I think scale is the main thing Gvt needs to control). 21c hit with multiple penalties that seem huge to us but were inconsequential to them.
In a small place, dealing with a few insurance rejections can make your week suck depending on admin's response. Smaller scale begets accountability.