If a Physical Therapist Does Not Have Full Control

Is an independent contractor really independent?  Is there a possibility for an arrangement that puts the independent contractor at risk?  How can the risk be minimized?

Sometimes journalists don't report accurately and make mistakes.  This particular news article is interesting.  A rheumatologist, office manager and billing clerk were hauled to jail May 1st.  Why?  Apparently, a massage therapist was providing massage services in office space of the practice as an independent contractor.  Patients were referred to the massage therapist.  It appeared to me that even though the massage therapist was an independent contractor, the physician practice billed for the massage therapist services.  (Is this sounding familiar??  Is anyone thinking of a particular opportunity physical therapists may have as an "independent contractor" with physicians?  Hint, hint. )

You can read the article... major upcoding issues occurred.   Insurance plans did not have covered benefits for the services provided by massage therapist.  The physicians, who obviously had control over billing for claims, sent claims for services designated for physical, occupational and speech therapy.  Which insurance companies were upset?  Medicare (of course) AND Blue Cross Blue Shield!

It sounded like things got worse... when things get worse, that indicates to me upcoding wasn't a mistake... intentional fraud is how I would interpret the choice of actions of those involved.

Interesting what can happen when the right hand doesn't know what the left hand is doing.... the message to us all - be careful with your business contracts and the physical location arrangements.  Also... I'd love to know MORE specifics.  This particular case begs to question if 97140 is owned by physical, occupational and speech therapists.  The devil is in the details, but this would be a particular court case of interest as we battle an argument that we don't "own" any codes.

~Selena