Physical Therapy Comes Under Scrutiny as Area for Potential Medicare Fraud

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If one were asked what type of medical professional would be in receipt of millions of dollars from Medicare, cardiologists, oncologists or some other high-value speciality of medicine would probably rank highly as likely answers. Few would suspect that a physical therapist could rake in multimillion-dollar revenue from the government, but San Francisco healthcare fraud attorney Gregory J. Brod would not be surprised that such a calling has turned out to be a leading field for drawing Medicare dollars – and some justifiable scrutiny.

In fact, according to a recent report in The New York Times, physical therapists working in offices managed to draw $1.8 billion from Medicare in 2012 alone, making the field the 10th most lucrative field for Medicare payments among 74 medical specialties. On average, physical therapists collected $49,000 in Medicare payments in 2012, and those therapists who drew significantly higher amounts have attracted the attention of experts who have followed the issue and suspect potential fraud.

It turns out that Brooklyn has been an epicenter for big hauls from Medicare for physical therapists. Indeed, of the 10 physical therapists nationwide who were paid the most by Medicare in 2012, half offered their services out of Brooklyn addresses. And one therapist working in a modest-looking office in the Coney Island neighborhood of the borough, Wael Bakry, collected a whopping $4.1 million from Medicare in 2012. In that year, Bakry’s practice treated about 1,950 Medicare patients, and he was paid by Medicare for 94 separate procedures for each one of those patients. Extrapolating those numbers on an annualized basis, there would have been about 183,000 treatments for the year, 500 per day and 21 per hour, a pace all the more remarkable because one person purportedly performed all of the treatment from Bakry’s office, according to Medicare billing records.

The eyebrow-raising numbers notwithstanding, Bakry has contended that Medicare never questioned his billing practices nor denied payments to his office. Bakry also contended that his practice had about two dozen physical therapists and assistants working from four offices in 2012 – the care all those employees provided went under his Medicare billing number because he owned the practice. And Bakry does not appear on a database of providers who are excluded from the Medicare program.

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Federal authorities have suspected that physical therapy is a tempting field for fraudulent billing because unscrupulous practitioners can more easily bill Medicare for unnecessary treatments or procedures they never perform – known as fake or phantom billing – than in other medical fields such as cardiology or oncology. And, with the nation’s population increasingly tilted toward older, more healthcare-relient people, the demand for physical therapy as well as opportunities for schemes to defraud Medicare is bound to multiply.

In Brooklyn, the federal government’s law enforcement efforts have already yielded major results, including a physical therapist who pleaded guilty in 2011 to submitting almost $12 million in false or fraudulent claims to Medicare during a period of five years.

As in the case of any successful uncovering of a fraudulent scheme against Medicare, it is often a brave whistleblower who steps forward as sanctioned by the federal False Claims Act to report the pilfering of funds from Medicare, which would be the basis for a qui tam lawsuit on behalf of the government. We applaud such whistleblowers who play a role in combatting theft against the taxpayers and the U.S. Treasury as well as against the upward pressure on premiums and healthcare costs that Medicare fraud encourages, and we urge anyone with information on fraud against Medicare to contact the experienced attorneys at the Brod Law Firm for a free consultation.
-James Ambroff-Tahan contributed to this article.

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