US Attorney Sherri A. Lydon announced on May 9 that the United States Attorney's Office for the District of South Carolina has resolved claims of health care fraud with Carolina Physical Therapy and Sports Medicine, Inc. ("Carolina PT"). Carolina PT had nine physical therapy practices in South Carolina, in Columbia, Irmo, Lexington, Sumter, and Mount Pleasant respectively.
The United States alleged that Carolina PT knowingly submitted false claims to Medicare and TRICARE for "services provided to multiple patients simultaneously as though the services were being provided by a physical therapist or physical therapist assistant to one patient at a time." As a result of this false billing, Carolina PT received higher reimbursement than it normally would have had it submitted its billing accurately.
Further, the United States alleged that Carolina PT knowingly submitted false claims to Medicare and TRICARE for services provided by physical therapy assistants who were not supervised by a physical therapist as is required by law.
The United States also contended that Carolina PT knowingly submitted false claims for "attended electrical stimulation services when those services were in reality not attended by a licensed therapist or assistant." These services should have been billed as a lower cost unattended electrical stimulation service, but were not.
This settlement came out of a whistleblower lawsuit filed in South Carolina by a former employee of Carolina PT. The relator will receive $142,000 from the settlement.
“Medical billing fraud drives up the cost of healthcare and diverts critical resources from federal healthcare programs,” U.S. Attorney Lydon said. “Whistleblower suits, like this one, are one of the government’s most effective tools at detecting fraud and protecting the integrity of our burdened healthcare system. The U.S. Attorney’s Office for the District of South Carolina will continue to pursue companies and providers that defraud federal health care programs.”
If you are aware of fraud against the government, whether in healthcare or another sector, you may be eligible to blow the whistle in a False Claims Act lawsuit and may be entitled to a portion of the recovery. To find out more, contact Goldberg Kohn for a confidential consultation.