Medicare Compliance & Reimbursement

Rehab owner pleads guilty to billing fraud in Medicare probe.

Playing fast and loose with a physician's Medicare provider number has landed a rehab clinic operator in hot water with the feds.

Pamela Sampson, administrator and part owner of Alpha Healthcare Services Inc. in Opelousas, LA, pleaded guilty June 18 to health care fraud after coming under the scrutiny of the HHS Office of Inspector General and the Department of Justice. According to U.S. Attorney Donald Washington, Sampson submitted Medicare claims for services purportedly provided incident to a physician's supervision when the physician wasn't in fact involved.

In addition, prosecutors maintain that Sampson billed for services not rendered and paid herself hefty consulting fees out of money she derived from the improper claims.

Sampson faces up to 10 years in prison and a $250,000 fine.

Lesson learned: Therapists must make sure the physician's presence can be documented when billing for incident-to services.