Apr 10
28
More Physical Therapy “Sham” Operators Indicted in South Florida
The United States Attorney’s Office for the Southern District april 23rd Press Release details yet another case of sham physical and occupational therapy operations in South Florida. This is another story of kickbacks for referrals, non-licenses physicians and therapists, submitting fradulent claims to Medicare, and a web of shell corporations to hide the illegal payments.
According to Jeffrey H. Sloman, United States Attorney for the Southern District of Florida, and John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation:
the conspirators defrauded the Medicare program in various ways. First, the conspirators submitted fraudulent claims to Medicare on behalf of Infinity Therapy, Mega Therapy, Miami Dade Medical and Florida Rehabilitation Clinic for PT/OT services rendered by unlicensed and unqualified physical therapists, occupational therapists, and therapy assistants. Second, the conspirators submitted false claims to Medicare for PT/OT services allegedly rendered to Medicare beneficiaries who, unbeknownst to the Montaners, were actually cooperating government witnesses. Third, after February 2008, when a complicit supervising physician working for Ernesto Angel Montaner died of natural causes, the conspirators continued to submit claims to Medicare for PT/OT services that were primarily overseen by a “physician” who was not actually licensed in the United States. Fourth, the conspirators created “billing templates” that were designed to ensure that Medicare was typically billed for at least seventeen PT/OT sessions, using an optimized set of predetermined billing codes, regardless of how many times the Medicare beneficiary actually visited the clinic, and regardless of the Medicare beneficiaries’ actual health. The conspirators also used certain billing codes, known as “modifier codes,” to bypass Medicare’s normal annual financial limits for PT/OT services. Based on these schemes and others described in the charging documents, the conspirators submitted more than $2.5 million of false claims to Medicare.
Apparantly the effective use of undercover government agents, posing as patient recruiters, was one of the underpinnings of the sham operation. The legitimate therapy community should also sit up and take notice of the reference to the “therapy template” commnets in the press release, as well as comments related to the use of modifiers. It is likely that this information, while helpful in pulling the case together on this indictment along with a variety of illegal activities, is a tool that is being used in therapy provider profiling. It is something to add to your risk assessment if you are a therapy provider, particularly in Florida!
