High-Profile Federal Fraud Convictions Serve as Reminder to Know and Follow Practice and Insurance Laws

Posted on August 2, 2018 by Chapter Staff
Originally Published in HAPTA’s e-Newsletter, What’s HAPTAnin’ – August 2018

Recent events in Hawaii serve as a stark reminder of the importance of complying with our state practice act and the serious consequences of health insurance fraud. Two recent court cases found island physical therapists guilty on multiple counts with the sentencing phase scheduled in August.

The first case deals with a pattern of falsifying claims and documentation. A clinic owner directed staff to create false invoices and false therapy notes for dates when no treatment took place. In addition, billing was submitted utilizing the name of a therapist who was on leave. In the second indictment, over a six-year period, the therapist submitted bills to insurers under his unique provider number for services he did not personally render. In addition, contrary to our state rules, the billed services were conducted by unlicensed staff.

The aftermath of these federal violations will be considerable. Each case carries the possibility of an extended incarceration in addition to hefty fines. Furthermore, the Hawaii Board of Physical Therapy will determine the professional repercussions of these actions.

As licensed professionals, it is our duty to be knowledgeable about state and federal laws about who may provide treatment and when we can bill for treatment. Furthermore, as professionals, we should encourage our peers to practice within the framework of our Code of Ethics along with state and federal law. Find the statutes and rules that govern physical therapy in Hawaii on the DCCA website. And find resources about coding and billing on the APTA website.

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