A Home Health Agency that uses a massage therapist to provide physical therapy services results in false claims when submitted to Medicare for reimbursement
Compliance Perspective – Fraud
Policies/Procedures: The Compliance and Ethics Officer with the Human Resource Manager will review policies and procedures involving licensure of personnel who provide therapy services to patients.
Training: The Compliance and Ethics Officer with the Human Resource Manager will ensure that staff are trained on the process for confirming that staff meet initial licensure requirements, renewals, continuing education,and self-reporting of any instance where a license has been revoked or suspended.Licensed staff will be made aware of the need to report any information they may receive regarding an event that might result in the suspension of their or another staff member’s license.
Auditing: The Compliance and Ethics Officer with the Human Resource Manager will personally conduct an audit to ensure that the licensure requirements of all personnel have been verified and are current.
The owner and operator of a Florida home health agency pleaded guilty to one count of conspiracy to commit healthcare fraud before a U.S. District Judge of the Southern District of Florida. The owner’s co-conspirator, a licensed massage therapist, also pleaded guilty to one count of conspiracy to commit healthcare fraud. Sentencing is scheduled for Feb. 5, 2019.
As part of his guilty plea, the owner admitted paying kickbacks and bribes to his co-conspirators in exchange for home health services prescriptions and referrals of Medicare beneficiaries to his Florida home healthcare company. He and his co-defendant admitted that together with their other co-conspirators they committed healthcare fraud by arranging for the massage therapist to render therapy services on behalf of licensed therapists despite the fact she was not licensed to render physical and occupational therapy services to the Medicare beneficiaries. They falsely billed Medicare for those services. As a result of the fraudulent claims, Medicare paid $8.6 million in fraudulent benefits. The pair were indicted on June 21, 2018.
