Healthcare Compliance Perspective – Healthcare Fraud:
Services provided by non-licensed persons and claimed as performed under a licensed provider’s unique Medicare provider number for reimbursement are not allowed by Medicare and Medicaid and are considered fraudulent.
From January 2011 through October 2017, he submitted false claims for payment of physical therapy services to TRICARE, Medicare, Medicaid, and HMSA. He submitted claims to these health care benefit programs using his unique provider number, thereby falsely stating that he, himself, had personally provided the physical therapy services to his patients, when the services were provided by his unlicensed staff members, including at times when he was travelling in the U.S. mainland or in a foreign country. The government alleges that he billed approximately $5.5 million of false claims for services provided by his unlicensed staff members, of which approximately $3.7 million was paid. The defendant reserved the right to challenge the loss amount in his plea agreement.
Sentencing for the man is scheduled for August 6, 2018 before a U.S. District Judge. For each count, the man faces up to 10 years in prison, a fine of up to $250,000, and a period of supervised release of up to three years. The man agreed to pay restitution and agreed to forfeit the proceeds of his unlawful activity, in amounts to be determined by the Court.
