• Wednesday, June 18, 2014RSS Feed

    'Rock Doc' Gets 6 Years for Medicare Fraud Involving 'Physical Therapy'

    The so-called "Rock Doc" who pleaded guilty to defrauding Medicare of $2.6 million through bogus physical therapy services has been sentenced to 6 years in prison.

    In addition to the billing fraud, Christopher Gregory Wayne, 54, of Miami Beach, Florida, also admitted to illegally prescribing controlled substances and has been ordered to repay Medicare about $1.65 million. The sentencing, which occurred on June 13, was reported in the Wall Street Journal and Miami Herald, among other outlets.

    Wayne was the subject of a 2010 WSJ front-page article that tracked nearly $1.2 million in payments from Medicare, mostly for "physical therapy" that was not provided by licensed physical therapists—or not provided at all. The family physician earned his nickname thanks in part to his high-profile lifestyle and punk appearance, complete with spiked blond hair.

    According to the Herald article, Wayne told the judge at his sentencing hearing that the billing abuse "was not intentional or malicious." Instead, Wayne claimed that he was simply unaware of 2008 Medicare changes that required his employees to be licensed PTs.

    The headline-making nature of Wayne's crimes underscores the importance of maintaining a strong professional understanding of fraud, abuse, and waste. APTA's Integrity in Practice campaign supports physical therapy's high practice standards by helping PTs understand regulations and payment systems, and putting them in touch with tools and resources that promote evidence-based practice, ethics, and professionalism.

    Check out the latest addition to the Integrity in Practice webpage: Preventing Fraud, Abuse, and Waste: A Primer for Physical Therapists (.pdf) is a free guide that examines not only the laws around these issues but the ways in which PTs can avoid fraud, abuse, and waste with payers, referral sources, and patients.


    Comments

    It is a shame that this has been considered PT fraud when there was no PT involved. I hope CMS realized the actual source of the fraud when they decided it was necessary to have PT's "jump through more hoops" in order to be paid for our valuable/legitimate service. example: Our clinic follows the rules and currently has 2 unpaid claims that exceeded the cap and 1 of them exceeded the $3400.00 manual review amount. Both were seniors that had multiple injuries/interventions during the year of 2012. Claims were mismanaged through CMS's outgoing Palmetto GBA and not transitioned properly to Noridian. After spending a year reopening the cases and redoing the early level appeals, there is now an additional 28 month!!! wait for the cases to be heard. I wonder if the "Rock Doc" had as much trouble getting Medicare to pay his $2.6 million as I am having to get these 2 claims paid. In my world these unpaid claims represent 2 months of clinic space leasing or 10 months utilities. I applaud Medicare's efforts to combat fraud and am very glad that they were finally able to prosecute this Dr that believed he was above all rules and even implied that he was unaware of the rules(Ha). What is now most important for CMS to consider is how to reduce fraud without making it impossible for legitimate PT's to treat patients and get paid for those services.
    Posted by Betty Fackler on 6/27/2014 2:18 AM
    Nursing home Physical Therapist gives 90 year old late stage crippled Terminal Alzheimer's patient 60 PT sessions called "Self care or Home Management Training (CPT 97535)" - billed to Medicare. Can anyone tell me what benefit that would be to the patient and is this Medicare Fraud?
    Posted by Don Siedenburg on 10/25/2014 11:53 PM
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