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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Medicare Fraud: Is Your Practice in Line?

Published July 1, 2010 10:19 AM by Cheryl McEvoy

Whenever I see "Improper Medicare Billings" in the headlines, I think, Another one bites the dust. Health care fraud accounts for an estimated $60 billion each year, and quite frankly, I don't feel like paying more taxes just so a provider can shirk the government out of some cash.

Usually, the stories that get me are the practices owners who blow their overpayments on a hot car or exotic vacations. Lamborghinis rarely fly under the radar, and they'll likely pay for the lavishness 10-fold.

But are all fraudsters just that? The term "fraud," by definition, implies some type of willful intent, while "abuse" is usually reserved for innocent or unintentional mistakes. With so many rules dictating Medicare and Medicaid reimbursement, especially for physical therapy, it seems like errors are inevitable. But when does it cross the line from careless to criminal?

In one of the latest cases of alleged Medicare fraud, a physical therapy practice agreed to pay $1.8 million to the federal and state governments for improper claims. According to reports, an investigation found the facility had submitted claims for "therapeutic exercise" when it really provided aquatic therapy, while other claims failed to meet medical necessity.

The practice admits no wrongdoing in the settlement, so were the improper billings just a way to get around, say, aquatic therapy restrictions? Perhaps, but that's not important--at least for investigators. For them, the government got its money and the facility got a fiscal slap on the wrists. Mission accomplished.

Fraud investigations are just gearing up: President Obama has declared fighting fraud a priority and plans to increase the number of "strike force teams" on the hunt for faulty claims. So keep reading Medicare Advisor, both in print and online, to ensure your billing practices are up to code, and follow The Politics of Health Care blog to stay abreast of regulatory changes. And as for those drowning in aquatic therapy rules, we'll be launching a new column in the coming weeks to keep your pool-based practice afloat.

4 comments

Scary- is it not.. Shame that the person who ends up short is the patient as the cargivers must walk on eggs to do what they are feeling is right..  Let's face it.. All medicine is "practiced"..  

And so is law..

I thought or have been told that I am "terminally ill"..

And I am not allowed to choose my fate..?  That is what is really wrong.

Let's face it.. the living are here to be fools and to do the fooling.

No wonder "evil" pays the rent for so many.

I guess I am to believe that JC will save us all..

Whoops, he does not take Medicare... Can you blame him.

John April 15, 2011 12:02 PM

I have seen so much of this. Getting pressure to take severe dementia patients or those who are on comfort care. And then have them with high rugs 60 to 75 mins? Torture. Then if you say something and refuse, guess what? You lose your job. This is fraud.

katie, occupational therapy - OT, avalon November 13, 2010 3:00 AM
pasco WA

what do u think of putting actively dieing patients on case load in ultra high rugs cats for a week or 2 until hospice takes over...billing a dying pt 300 dollers a day between ot, st and pt.This happens in long term care all the time..Poor patients.. Its discusting. unethical and fraud. How can we protect our pts..Also how can we protect our licence and jobs

fred July 13, 2010 1:16 AM

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July 2, 2010 11:23 AM

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