The government issues press releases all the time announcing that a physical therapy business has been caught submitting false claims to Medicare.  The government uncovers these false claims in two ways:  (1) by offering very large rewards to patients, employees, and others who report the fraud and help recover over-payments; and (2) by using computer software tools to identify suspicious billing patterns.

False claims for physical therapy services take many forms.  In the most recent case, the owner of a physical therapy service (who was not herself a physical therapist) was caught billing Medicare for physical therapy services under the name and provider number of a physical therapist who no longer worked at her company.

The services were actually provided by unsupervised non-physical therapist employees such as physical therapist assistants, massage therapists, and massage therapy students.  Those “physical therapy” services billed to Medicare did not qualify for reimbursement, because they were not rendered by, or under the supervision, of a licensed physical therapist.

When a whistleblower helps the government uncover this type of false claim through something called a qui tam action, the government pays the whistleblower a reward of between 15% and 30% of the amount the government recovers.  Since the government can go back several years -- and can recover three times the amount of the overpayment plus penalties -- those rewards can add up to hundreds of thousands and sometimes millions of dollars.

If you are aware of false claims being submitted to Medicare or Medicaid, then you should consult with an experienced lawyer immediately to protect your rights.  To schedule a free and confidential consultation by telephone or in person, call my office today at (212) 601-2728 or click here to communicate with me via email.

John Howley
New York, New York

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05/08/2013 3:29am

This post indicates the major False claims for physical therapy services. Thanks for your nice sharing.


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