Physical therapy fraud is a common form of healthcare fraud that may violate the False Claims Act. It occurs where 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.
Types of Fraud in Physical Therapy
Fraud can take many forms, including:
- Billing for medically unnecessary services.
- Upcoding services from a lower cost to a higher one.
- Billing for services that were never performed.
- Billing for services an unlicensed person provided.
- Billing for services performed at an unlicensed location.
Another common type of physical therapy fraud involves unlawful kickbacks. Such kickbacks may occur where physicians or therapists receive payment or other items of value (e.g., services, vacations, commissions, speaking arrangements, paid titles and positions, below-market leases, etc.) in return for patient referrals for physical therapy services that are reimbursed by the government. Providing referrals to health care providers where the doctor has a financial relationship, or where his or her family has a financial relationship, may also result in false claims where the government pays the bill.
Examples of Physical Therapy Fraud
In response to the widespread occurrence of physical therapy fraud, the government has strengthened its efforts to pursue billing fraud and overpayment cases. Whistleblowers have come forward to shine a light on these dishonest practices.
For example, in 2019, a former employee of Carolina Physical Therapy and Sports Medicine, Inc. asserted False Claims Act allegations that led to a $790,000 settlement. The government alleged that Carolina PT submitted false billing through TRICARE and Medicare for services multiple patients received at once, though the bill claimed Carolina PT treated a single patient at a time. This deceptive billing practice triggered higher payments from government healthcare programs. The government also alleged that Carolina PT submitted claims for services by physical therapy assistants who should have been supervised by licensed physical therapists, and other services that were not attended by a licensed therapist or assistant.
In addition, a chiropractor received a 30-month prison sentence in 2020 for his role in a $15 million Medicare fraud case in which physical therapy services were not performed or were performed by unlicensed staff. In another case in 2020, Diversicare Health Services paid $9.5 million to resolve allegations of providing unnecessary or unskilled physical therapy services.
Contact Our Physical Therapy Fraud Attorneys
The physical therapy fraud lawyers at Goldberg Kohn work with whistleblowers to fight all types of healthcare fraud. Our team can assist you if you suspect physical therapy fraud or want to discuss your legal options. Contact us today to schedule your free and confidential consultation.