Allegations of false physical therapy coding and false bills for unnecessary physical therapy have resulted in a return of $1,625,489.25 to the federal government and $190,977.75 to the State of Tennessee, for a combined settlement payment of over $1.8 million by Ooltewah, Tennessee-based, Tenn-Benchmark Rehabilitation Partners, LLC. Tenn-Benchmark owns and operates Benchmark Physical Therapy, which operates in 46 different locations in Georgia and Tennessee as well as three other separate physical therapy providers. According to a statement issued by the U.S. Attorney for the Eastern District of Tennessee, the false claims occurred during a five-year period between 2001 and 2006, during which aquatic therapy (which is subject to strict reimbursement restrictions) was fraudulently billed as physical therapy to Medicare and Medicaid. Additionally, state and federal prosecutors alleged that Benchmark knowingly billed for unneccessary therapy services, a fraud that is becoming increasingly common.
In 1994, the Office of Inspector General, Department of Health and Human Services published a report finding that 78% of physical therapy billed by physicians did not constitute true physical therapy. In 2006, OIG published another report, stating that a staggering 91% of physician physical therapy bills submitted in the first half of 2002 were deficient in at least one regard. Frohsin & Barger has investigated, identified, and uncovered the following types of physical therapy fraud:
(a) billing for physical therapy services performed by unqualified personnel;
(b) billing for physical therapy services that were never performed or only partially performed;
(c) billing for physical therapy services when, in fact, the service performed was unskilled, or amounted to maintenance therapy, or both, and did not constitute physical therapy;
(d) billing for physical therapy services performed under a deficient plan of care;
(e) billing under individual therapy codes for group therapy services; and
(f) illegal kickback arrangements among physical therapy providers, skilled nursing facilities, and other healthcare providers.
Although Benchmark has disclaimed any wrongdoing, U.S. Attorney James Dedrick stated that the $1.8+ paid by Tenn-Benchmark “will compensate the Medicare and Medicaid trust funds and TennCare for moneys paid out of those funds which Benchmark improperly claimed and received.” Whistleblowers who are aware of false claims to Medicare and Medicaid are entitled to between 15-25% (and in some instances as much as 30%) of any recovery by the United States or the State of Tennessee and certain other states under the respective federal and state false claims acts.