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The federal government and other payers rely on physical therapists to use their clinical judgment to provide patients with appropriate services and to submit proper claims for payment with accurate information. While the vast majority of health care providers are ethical and provide high-quality care, the few who abuse the system are costing payers and consumers billions of dollars and place beneficiaries’ health at risk. Beneficiaries who have had services billed improperly under their identity could later be denied coverage for services when they need them.

The prevalence of health care fraud, abuse, and waste has resulted in the need for laws, regulations, and other policies to prevent their occurrence.

This document provides physical therapists with information on how to comply with the relevant laws and regulations by identifying risk areas that could lead to potential liability.


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The Realm-Individual Process-Situation model of ethical decision-making — often called the RIPS model — was developed to address the various influences