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Physical Therapist To Pay $328K to Resolve False Claims

Published 02/25/2013 12:00 AM
Updated 02/25/2013 03:40 PM

Press Release from the United States Attorney for Connecticut
Zip06

The United States Attorney for the District of Connecticut announced that Todd Roberts, 47, of Old Saybrook, was sentenced today by United States District Judge Stefan R. Underhill in Bridgeport to three years of probation for obstructing a federal audit. Roberts and his physical therapy practice, Roberts Physical and Aquatics Therapy, also have entered into a civil settlement agreement with the government in which they will pay $328,828 to resolve allegations that they violated the False Claims Act.

According to court documents and statements made in court, on January 23, 2009, a Medicare contractor informed Roberts Physical and Aquatic Therapy, located at 210 Main Street in Old Saybrook, that the contractor was performing an audit of the practice. Roberts instructed an employee to delay the audit by telling the contractor that medical records were stored at a nonexistent storage facility. Roberts then rented a storage unit at a local facility and used the delay to alter and augment patient records. Specifically, Roberts, and an employee at his direction, created and added patient progress notes when no notes had been created at the time of service. The notes made it appear as though Medicare beneficiaries had obtained direct, one-on-one service from a licensed physical therapist when, in fact, some of the services had been rendered by unlicensed auxiliary personnel.

On September 25, 2012, Roberts waived his right to indictment and pleaded guilty to one count of obstructing a federal audit.

The civil allegations against Roberts and Roberts Physical and Aquatic Therapy involve improper billing to Medicare for Physical and Aquatic Therapy services between April 2007 and March 2010. The Medicare program only pays for outpatient therapy services that are provided by qualified personnel. Personnel qualified to provide outpatient therapy services are limited to physicians, licensed physical therapists, and licensed physical therapy assistants. The Medicare program does not pay for physical therapy services provided by supportive personnel, such as physical therapy aides, athletic trainers or student trainees. In addition, Medicare regulations and policies make it clear that therapeutic procedures require direct, one-on-one contact between the licensed therapist and the patient.

The government alleges that Roberts and Roberts Physical and Aquatic Therapy regularly billed Medicare for direct, one-on-one therapeutic procedures when such services were not provided. At the clinic, physical therapists and physical therapy assistants would routinely provide therapy services to multiple patients at the same time. Nevertheless, the services provided to each patient were billed as if the physical therapist or physical therapy assistant had provided direct, one-on-one care. For example, patients were routinely left alone to perform exercises in the aquatic therapy pool, with no direct, one-on-one contact with licensed personnel.

In addition, Medicare regulations and policies make it clear that physical therapy services must be thoroughly and accurately documented in the patients’ medical chart. Therapy services are only payable when the medical record consistently and accurately records the covered therapy services. The government alleges that Roberts and Roberts Physical and Aquatic Therapy routinely failed to document their therapy services. This was particularly egregious during the first six months of its operation, when the clinic did not have any documentation at all showing that the services in question were actually provided.

To resolve their liability under the False Claims Act, Roberts AND Roberts Physical and Aquatic Therapy will pay $328,828 for conduct occurring between April 5, 2007 and March 31, 2010.

In addition, Roberts and Roberts Physical and Aquatic Therapy have entered into a six-year Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with the requirements of the Medicare program, including the proper rendering of therapy services and the submission of only valid claims to Medicare for payment.

In entering into the civil settlement agreement, Roberts AND Roberts Physical and Aquatic Therapy did not admit liability.

Judge Underhill required Roberts, as conditions of his probation, to comply with the terms of the Integrity Agreement and to pay the entire $328,828.

This matter was investigated by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, and the Office of the Inspector General for the Department of Veterans Affairs. The case was prosecuted by Assistant United States Attorneys David J. Sheldon and Richard M. Molot, and Auditor Susan Spiegel.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.

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