Physical Therapy Practice Found Guilty of Health Care Fraud and Sentenced to Jail

April 15, 2011 · Posted in Industry News, physical therapy, Reimbursement · Comment 

PTManagerBlog.com recently reported that a married couple, the owners and operators of Superior Physical Therapy in Sault Ste. Marie, MI, was sentenced to jail after being found guilty on charges of health care fraud.

Aaron Clark, the physical therapist at Superior Physical Therapy, admitted to felony health care fraud in a written plea agreement and will spend two years in federal prison with 3 years of supervised release. He has been ordered to pay $345,000 in restitution to Blue Cross Blue Shield of Michigan and Medicare.

Michelle Clark, the biller who admitted to a misdemeanor count of theft from a health care benefit program, will spend 90 days in prison with a year of supervised release. She will also pay $345,000 in restitution.

The two were sentenced in U.S. District Court in Grand Rapids, MI.

Medicare Strike Force Charges 111 Individuals, including some PTs and OTs

The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing.  As released by The United States Department of Justice, there were a number of physical and occupational therapists indicted (an indictment is merely a charge and defendants are presumed innocent until proven guilty).

 

The Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.   

 

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, money laundering and aggravated identity theft.   The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment.  

 

According to court documents, the defendants charged participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes, never provided.   In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, health care company owners, executives and others charged in the indictments and complaints are accused of conspiring to submit a total of more than $225 million in fraudulent billing.

 

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

 

Since their inception in March 2007, Strike Force operations in nine districts have charged more than 990 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

              

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.