Medicare Fraud: Is Your Practice in Line?
Whenever I see "Improper Medicare Billings" in the headlines, I think, Another one bites the dust. Health care fraud accounts for an estimated $60 billion each year, and quite frankly, I don't feel like paying more taxes just so a provider can shirk the government out of some cash.
Usually, the stories that get me are the practices owners who blow their overpayments on a hot car or exotic vacations. Lamborghinis rarely fly under the radar, and they'll likely pay for the lavishness 10-fold.
But are all fraudsters just that? The term "fraud," by definition, implies some type of willful intent, while "abuse" is usually reserved for innocent or unintentional mistakes. With so many rules dictating Medicare and Medicaid reimbursement, especially for physical therapy, it seems like errors are inevitable. But when does it cross the line from careless to criminal?
In one of the latest cases of alleged Medicare fraud, a physical therapy practice agreed to pay $1.8 million to the federal and state governments for improper claims. According to reports, an investigation found the facility had submitted claims for "therapeutic exercise" when it really provided aquatic therapy, while other claims failed to meet medical necessity.
The practice admits no wrongdoing in the settlement, so were the improper billings just a way to get around, say, aquatic therapy restrictions? Perhaps, but that's not important--at least for investigators. For them, the government got its money and the facility got a fiscal slap on the wrists. Mission accomplished.
Fraud investigations are just gearing up: President Obama has declared fighting fraud a priority and plans to increase the number of "strike force teams" on the hunt for faulty claims. So keep reading Medicare Advisor, both in print and online, to ensure your billing practices are up to code, and follow The Politics of Health Care blog to stay abreast of regulatory changes. And as for those drowning in aquatic therapy rules, we'll be launching a new column in the coming weeks to keep your pool-based practice afloat.