April 17, 2013 — Connecticut physical therapist Todd Roberts has been sentenced to three years of probation for obstructing a federal audit into possible Medicare fraud. He has also settled civil allegations that he and Roberts Physical and Aquatics Therapy, his physical therapy practice, violated the False Claims Act. Under the qui tam provisions of the Act, insider employees and other private individuals are authorized to sue health care providers engaged in Medicare fraud and then keep a portion of any recovery. Provider employees are often in the best position to notice when fraud is occurring and to notify the government by filing a False Claims Act lawsuit.
Physical Therapist Alleged to Violate Medicare Documentation Rules
Medicare pays for outpatient therapy only when one-on-one services are given to the patient by a doctor, licensed physical therapist or a licensed physical therapy assistant. Medicare will not reimburse for physical therapy services performed by an athletic trainer, physical therapy aide or a student trainee. In addition, physical therapists are required by Medicare to document their sessions in the patient’s chart.
But according to the FBI, from 2007 to 2010, Roberts and Roberts Physical and Aquatics Therapy routinely submitted claims to Medicare for one-on-one therapeutic services even though the services were provided to more than one patient at a time. Further, they allegedly failed to document the therapy provided in a thorough and consistent manner. During the first six months of its operation, Roberts Physical and Aquatics Therapy made no documentation at all, claims the government.
The misconduct came to light in 2009 when Roberts Physical and Aquatics Therapy was notified by a Medicare contractor that the physical therapy clinic would be audited. Roberts told an employee to inform the contractor that the medical records could not be audited at the time because they were located offsite in a storage facility. Roberts allegedly then rented an offsite facility where he and an employee created the missing documentation and fabricated records.
Roberts’ settlement of the False Claims Act allegations will cost him $328,828.
Health Care Insiders Collaborate with Government on Medicare Fraud
Many False Claims Act allegations involving Medicare fraud are reported by tipsters who are employed by health care providers. Before filing a qui tam case, government collaborators should learn their own rights. The whistleblower lawyers at Waters & Kraus provide conscientious informants with the aggressive legal representation they need. Contact us or call our Medicare fraud attorneys at 800.226.9880 to discuss how we can advance and safeguard your interests.