OIG Cracks Down on Physical Therapy Billing

No doubt most PTs reading the headline of this post immediately got a warm flash and thought about what procedures to add to their already onerus administrative burden so as to avoid making a billing mistake; understandable, just a natural reaction due in part to the "Peace-Corps gene" so often found in PTs.

Not to worry though, most of the primary perps in this report here weren't PTs.....they were physicians (and in one case cited uscrupulous PT co-conspirators)!!    On second thought, worry because it seems PT billing will be under closer scrutiny (due in large part to physican violations).

You can access the report directly via the link above, but I pasted the pertinent citation text below for ease of access and so it is out in the open on this blog for all to see......very ugly laundry indeed.

Question:  Wouldn't we all be better served (ironically, including the third party payors in this case) by just doing the right thing-- having PTs be the only ones billing for PT codes?

Rob

 

"Your physical therapy billings could be a major hot button in the new year, judging from the HHS Office of Inspector General’s (OIG) semi-annual report on fraud & abuse. 

A Texas physician received an 11-year, three-month sentence for taking part in schemes to defraud Medicare and Medicare, the OIG notes. He accepted money from clinic owners in exchange for signing charts for physical therapy, helping the clinic owners to submit false claims. In another scheme, the doctor ordered motorized wheelchairs for patients whom a company transported to his office and performed unnecessary medical services for those patients. 

The number of physicians billing more than $1 million for physical therapy per year more than doubled from 2002 to 2004, the OIG found in a recent study. Claims for physical therapy increased from $353 million to $509 million during that period, and the OIG found “significant and persistent compliance and quality-of-care problems.” Doctors’ offices overbilled for services, used unskilled staff, and billed for services that didn’t meet Medicare coverage requirements."

Comments

[Sean]

It's not the least bit surprising to me. This is just another instance of RFP going hand in hand with overutilization of services by docs who own MRIs, Lab services, etc.
I can understand why initially a doctor would open his own facility due to the quality of care given in many of the hospital PT depts. in my area. They employ improper billing procedures, with non-adherence to pt supervision requirements.