Medicare Fraud and Physical Therapy

Medicare fraud is conducted every day by many medical professionals, including physical therapists. However, many therapists unknowingly commit fraud because Medicare frequently changes the regulations that govern medical billing for therapy services provided.

Significance

• Incorrect or untruthful billing of therapy services to Medicare results in significant altering of the Medicare reimbursement for your facility. Therefore, Medicare views all inaccuracies as potential fraud and can prosecute, resulting in fines, termination, loss of licensure and certification and jail time.

Types of Medicare Fraud

• Medicare expects to be billed in exact minutes for treatments provided to a patient. If a therapist bills for more or less treatment time than they performed, they have committed Medicare fraud. Furthermore, all minutes billed must be performed in the direct line of sight of the patient--that is, with the therapist able to physically see the patient. Billing the incorrect code for the treatment also constitutes fraud because different codes change the reimbursement that your facility receives.

Prevention/Solution

• Therapy companies will often follow Medicare laws and notify their employees of applicable changes. Medicare, however, does not have any requirement to notify you of changes, and your ignorance of them does not protect you from prosecution. Because of the fluid nature of the laws that govern Medicare for therapy patients, physical therapists are advised to check Medicare's official website, Medicare.gov, frequently for changes.