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Monday, April 04, 2011RSS Feed

Zero Tolerance

News reports of alleged Medicare fraud seem to be a regular occurrence these days - a reality that should give pause to everyone in the health care field.

With the recent news that the Medicare Fraud Strike Force had charged 111 individuals - including four physical therapists - with fraud, the issue and its unfortunate consequences to patients and the health care system really hit home.

While all of these defendants are presumed innocent until proven guilty, news of physical therapy services being part of any fraud scheme is deeply troubling to APTA. We're not familiar with, and cannot comment, on the specific charges against the individuals cited in the lawsuits, but we have zero tolerance for the type of behavior alleged. APTA promotes only the highest standards of practice to its members. It is important that individuals receive physical therapy services that are of high quality and medically necessary, furnished by licensed physical therapists or physical therapist assistants under the direct supervision of a physical therapist.

APTA stands ready to work with government and private payers to bring an end to fraudulent activity within the health care system.

What are your thoughts regarding these recent Medicare fraud cases? Why do they seem to be increasing? And what can we, as health care professionals, do to help put an end to this behavior?

  • Posted by R Scott Ward at 8:56 AM
  • Labels: In the News


We assume that we all have the same concept of "medical necessity". In reality, everyone's concept is different and evolving with time and experience in health care. Even when medicare's definition is spelled out, it is quite difficult to apply the standard to practice when our patients come to us with different ideas of medical necessity and different levels of passion regarding the amount of service they deserve.
Posted by Margaret Holt -> @MVZ on 4/4/2011 9:19 AM
Why are the fraud cases increasing? Easy... some people will do whatever they can to make money. If you saw the DME fraud on 60 Minutes, apparently it isn't difficult to dupe the government. Fraud is increasing because the economy is horrible. Some people will do anything to survive. You know what's really sad in the physical therapy fraud cases? The issue isn't just a "provider" issue... there are people willing to sell their contract numbers for $50-100! Those same folks are willing to "sign" in at the fake clinic as if receiving services too! Those folks are just as wrong! No one speaks of the hundreds choosing to sell their number to allow fraud. If it were me, those folks would lose their contract numbers and no longer be allowed to receive services. They chose to steal from tax payers. How do you feel about me knowing your NPI, Scott? Your business location in 2007 was Salt Lake City, UT. Your NPI is: 1740370337 If CMS is so worried about fraud, why don't they do something to protect us providers? Who says I can't fill out some form stating you reassign your benefits to me and my company? How do we as providers know our NPI numbers aren't being fraudulently used? The majority of us are completely innocent, yet no one wants to protect us. If my Medicare B payer had the ability to NOT pay for services all based on a darn ICD-9 code (disallowing certain CPT codes), then I can assure you, CMS has reasonable information technology to make those type of payment decisions. I'm not sure why CMS wants to pay MORE money to screen and assess facilities when I would think there could be a really, really easy way to red flag what seems like crap. I am very sure they could look at the physical therapy fraud cases and see how those situations were vastly different than what typically occurs in physical therapy. They could have their snazzy claims processing have a way to keep track of dollars paid and have some sort of if/then rule to determine denials solely based on individual provider volumes and dollar amounts. They need to be smarter than the crooks... and they can't waste tons of time and money on the majority.
Posted by Selena Horner on 4/4/2011 12:13 PM
Where is the news about a potential government shutdown that will directly impact providers? Why focus on 4 PT's when you have thousands who may be out of business in the next ten years if republican plans move forward?
Posted by Robert Ingrisano -> ?GT\D on 4/6/2011 12:29 PM
We MUST be guided by and follow our ethical standards, not only because of how it reflects on us and our profession, but because it is THE RIGHT THING TO DO!! Let us leave behind this self-centered, look-out-for-number-one philosophy.
Posted by Gordon Oakes -> AGY[< on 4/8/2011 6:44 PM
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