Reporting Physical Therapy Fraud on Medicare or Medicaid Under the False Claims Act
If you are a health care insider who suspects physical therapy fraud, your actions could make a lasting difference. It's important to understand your role, rights and protections as a whistleblower.
Physical therapy fraud siphons resources away from genuine care and drains hundreds of millions of dollars from government programs like Medicare and Medicaid.
At Goldberg Kohn, our attorneys have substantial experience with False Claims Act litigation, including identifying and exposing physical therapy fraud. We provide confidential guidance to professionals who are considering reporting fraud, help safeguard their rights and help maximize potential rewards.
Common Types of Physical Therapy Billing Fraud
Physical therapy fraud is a common form of health care fraud in which a provider fraudulently bills Medicare or Medicaid for physical therapy services. Physicians, physical and occupational therapists, clinics, and ambulatory surgical centers may be liable for this type of fraud if they submit false claims to the government.
Under the False Claims Act, private individuals may come forward confidentially and initiate legal action when they discover physical therapy billing fraud, filing a qui tam lawsuit on the government’s behalf if they possess credible evidence of fraudulent practices. While the case is initially filed confidentially, it is eventually unsealed. If the case results in the recovery of government funds, the whistleblower, called a relator, may be eligible to share in the recovery.
Goldberg Kohn represents whistleblowers in a wide variety of PT Medicare fraud cases:
Billing for Medically Unnecessary Services
A provider may submit claims for physical therapy treatments that are not clinically indicated or justified by the patient’s condition, often providing prolonged care beyond what is reasonable or performing interventions without an evidence-based rationale.
Physical Therapy Upcoding
Upcoding occurs when a provider deliberately bills for a service at a higher reimbursement rate than the service actually delivered. For example, if a short, routine therapy session is coded and billed as a complex or extended session, this may result in higher payments from Medicare or Medicaid than are warranted.
Billing for Services Never Performed
Often referred to as phantom billing, this involves submitting claims for physical therapy sessions or treatments that never took place. The provider may document and bill for appointments the patient did not attend or for procedures that were never performed.
Billing for Services Provided by an Unlicensed Person
Legal regulations require that licensed physical therapists, or supervised and properly credentialed staff, provide care billed to Medicare and Medicaid. Billing for services performed by aides, technicians or individuals without the necessary licenses is fraudulent and poses a risk to patient safety.
Billing for Services Performed at an Unlicensed Location
Services must generally be provided at certified facilities that meet federal and state regulatory requirements. Billing for physical therapy conducted in offices or locations that lack the required certifications or licenses may constitute fraud.
What Doesn’t Qualify as Physical Therapy Fraud
While billing irregularities or other deceptive practices involving private insurance are often unlawful and may be subject to separate state or federal enforcement, they do not qualify for a qui tam lawsuit under the federal False Claims Act.
Case Studies: Whistleblowers and Physical Therapy Fraud
In 2024, a skilled therapy provider in Rockford, Illinois, agreed to pay $1.5 million to settle allegations that it submitted claims for services deemed medically unnecessary. That same year, Peak Physical Therapy, an Idaho-based company, paid $1.8 million after admitting to billing for services provided by individuals who were not properly credentialed.
In Florida, a physical therapy practice and its owners resolved allegations of submitting false claims for services allegedly performed when the therapist was not present in the country, resulting in a $750,000 settlement in 2026.
Take the Next Step: Report Physical Therapy Fraud With Confidence
If you have witnessed physical therapy fraud affecting Medicare, Medicaid or another government program, your decision to come forward could make a substantial impact on patient care and public resources.
Goldberg Kohn offers comprehensive guidance from initial investigation through resolution to help whistleblowers understand their options, legal protections and next steps. We are committed to protecting your interests and ensuring you receive the highest standard of legal advocacy. Reach out to our team to begin the conversation.
