Medicare Compliance & Reimbursement

PT clinic operators indicted for lying about physician evals. 

Two Texas physical therapy clinic operators are in hot water for allegedly fudging physician evaluations.

According to U.S. Attorney Michael Shelby, Monet Selders and Tamara Fitzgerald, operators of Infinity and Medical Management Services PT clinics, have been indicted by a grand jury for conspiring to commit health care fraud. Prosecutors say more than $2.6 million in 1999 claims submitted by the clinic were fraudulent.

In particular, the indictment maintains that Selders and Fitzgerald hired a foreign medical student - who was not a licensed doctor - to perform patient evaluations, then billed Medicare as if a licensed physician examined the patients. They also allegedly billed for services that weren't rendered and submitted claims for services provided by unqualified personnel.

In addition, the pair purportedly paid kickbacks for referrals for a number of individuals, paying referral sources a 10-percent cut of any Medicare reimbursement they were able to collect.

Lesson Learned: Don't play fast and loose with your bills for physician evaluations of rehab patients.