Submitting bills misrepresenting therapy services provided or for services not provided may result in the submission of fraudulent false claims.
Compliance Perspective – False Claims Allegations
Policies/Procedures: The Compliance and Ethics Officer with the Director of Therapy Services will review policies and procedures involving accurate coding for therapy services provided.
Training: The Compliance and Ethics Officer with the Director of Therapy Services will ensure that staff are trained to provide accurate coding for the therapy services provided.
Audit: The Compliance and Ethics Officer with the Director of Therapy Services will audit the medical records of residents receiving therapy services to determine if the therapy prescribed is the therapy that is provided and accurately coded for billing purposes.
A South Carolina occupational therapy and wellness center has agreed to pay $200,000 to resolve allegations that it knowingly submitted false or fraudulent claims to Medicare and Medicaid for physical and occupational therapy services.
The settlement resolves allegations that from November 2013 through April 2016, the center violated federal law by submitting bills for individual therapy services instead of the group therapy services provided. It is alleged that they also submitted bills for therapy services using the names and billing numbers of former employees who did not provide the therapy services. The center denies these allegations.
The initial lawsuit was filed under the qui tam whistleblower provisions of the False Claims Act that permits private parties to sue on behalf of the government regarding their belief that false claims have been submitted to the government.
