Billing Under Another’s Credentials Results in FCA Violation for Therapy Company

A Macon, Ga. rehab facility has been ordered to pay more than $9.6 million in damages after a district court judge ruled in favor of the government in a civil case alleging the fraudulent billing of hundreds of TRICARE and Medicaid claims.

The order was the result of a judge’s recent ruling in which he determined that the rehab facility and one of its owners were liable for 796 false claims that were improperly submitted to TRICARE and Medicaid.

The case originally was filed by a whistleblower, a Georgia-licensed occupational therapist who worked for the rehab facility performing patient evaluations and providing occupational therapy services. He claimed that during his three-month employment he witnessed defendants engage in fraudulent business practices including billing for services not rendered, upcoding for services provided, and billing for services provided by unqualified personnel. The government later intervened in the case.

According to the government’s investigation, the defendants filed claims in the names of three former employees during times when they had not rendered services. One was in jail at the time services were allegedly rendered, one was out of state and then resigned, the third had resigned and services were still being billed under her name.

The defendants admitted they submitted the claims under the therapists’ names after they left the rehab facility, but argued that it was a simple mistake, and therefore the government could not demonstrate the knowledge element of its FCA claim.

In analyzing the question of whether the rehab facility knowingly submitted the false claims, the court found that the owner’s conduct “epitomizes ‘reckless disregard’ of the truth.†Specifically, the court found that the submission of nearly 800 claims to Medicaid and TRICARE over an eight-month period following the resignation of one physical therapist and the submission of 41 claims following the resignation of a speech therapist could not be characterized as an “honest mistake.â€

The court granted the government’s request that the claims in the case on which summary judgment was not granted remain pending and that any other proceedings be stayed pending an appeal.

Under the False Claims Act, the government is entitled to three times damages and civil penalties ranging from $5,500 and $11,000 for each identifiable claim submitted between Nov. 2, 2015 – July 31, 2016, and a range of $11,181 – $22,363 for violations committed after Jan. 29, 2018.

The case demonstrates what can happen when services are billed under other providers’ credentials who did not provide the service. The Health Law Offices of Anthony C. Vitale can assist those who find themselves the target of an FCA investigation. For more information you can contact us at 305-358-4500 or send us an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.