Physical Therapist Assistant Convicted in $2.6 Million Healthcare Fraud Scam

A physical therapist assistant in Hialeah will be sentenced this month for her role in a $2.6 million healthcare fraud scam.

Tania Cesar was convicted of conspiracy to commit healthcare fraud and wire fraud, and five counts of healthcare fraud after a week-long trial.

Fraudulent Therapy Billing

It was alleged that from May 2019 through February 2021 Cesar, who worked at Elite Therapy Group Inc. in Miami, signed more than 1,500 notes for physical therapy treatments that she never provided to patients, resulting in more than $2.6 million in fraudulent claims billed to Blue Cross Blue Shield.

Healthcare Fraud Part of Larger Takedown

Cesar was among 14 defendants charged in connection with more than $1.9 billion in healthcare fraud who were prosecuted in the Southern District of Florida as part of the Department of Justice’s 2023 National Health Care Fraud Enforcement Action.

Those charges stemmed from various schemes to defraud government and private healthcare benefit programs by submitting false claims for items and services that were not needed and, in many instances, never provided.

The Co-Conspirators

According to court documents, Cesar worked with several co-conspirators at Elite Therapy, who previously were convicted for their roles in the Medicare fraud scheme. They are identified in court documents as Paola Andrea Wated, Maria G. Bou and Jose Geraldo Martin. Wated and Martin were owners of Elite. Bou was an employee and registered agent of Elite. She also is listed as owner of Celestial Therapy.

Two others, identified in court documents as Harol Lopez and Lidia Abrau, were allegedly paid, as part of the healthcare kickback scheme, to recruit patients. According to the indictment, they submitted approximately $4.3 million in fraudulent claims to insurance plans on behalf of Elite and another $1.4 million on behalf of Celestial Therapy.

Double the Trouble

Cesar had the same financial relationship with another clinic, Zion Medical, before she began signing false and fraudulent therapy notes at Elite, according to court documents. The owner of Zion testified that he and Cesar had the same agreement that Cesar had with the owners of Elite, Cesar would sign false and fraudulent therapy notes for treatments she never performed. These false and fraudulent therapy notes were also billed to BCBS as part of this healthcare fraud scheme.

Many of the hours she logged at one clinic, when added up with the hours for the purported physical therapy she signed for in fraudulent therapy notes from Elite, suggested that she was working more than 24 hours on multiple days. 

Co-Conspirators Testify Against Accused

Several co-conspirators in this healthcare fraud scheme, including the owners of Elite, testified that Cesar would come into the therapy clinic once or twice a week to sign the therapy notes but never treated patients. Some of Elite’s patients also testified that they had never received physical therapy treatment, nor had they ever met Cesar.

What’s more, Cesar signed false and fraudulent therapy notes for treatments she purportedly performed on dates when airline and U.S. Customs and Border Protection records confirmed that she was out of the country.

Not the First Time

According to court records in 2018, Cesar was fired by another company because she “billed for therapy services not provided” and failed to follow other policies and procedures.

Cesar will be sentence on May 6.

How We Can Help

Physical therapists must ensure that claims they submit for payment are supported by complete medical records and documentation. The Medicare and Medicaid programs and private payers may perform audits to review documentation to ensure the requirements are met.

If you or your company become the target of a healthcare audit, The Health Law Offices of Anthony C. Vitale has extensive experience representing clients in audits and overpayments and we can represent your interests through all stages of the process in an effort to achieve the most successful results.

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The Health Law Offices of Anthony C. Vitale