Part B Insider (Multispecialty) Coding Alert

Physician Notes:

Doctor in Hot Water for Billing Massage Therapist's Services As PT

Published on Mon Oct 26, 2015

Some people might consider time with a massage therapist their own personal form of therapy, but Medicare doesn’t consider the two synonymous. An Arkansas physician learned that lesson the hard way after he admitted to $2.2 million in fraudulent billing last week over this very issue.

The physician referred patients to a massage therapist for massage services, but the doctor billed the visits under his own number as if they were physical therapy. In fact, some of the claims were submitted when the doctor was not even on the continent. “Bills to health insurers ultimately surpassed $2.2 million,” the Department of Justice said in an Oct. 13 news release announcing the case.

“Our healthcare system relies on trust,” said Christopher R. Thyer, the U.S. Attorney handling the case in the release. “Insurers process millions upon millions of claims each year on good faith. Doctors and other providers who abuse this trust by submitting fraudulent claims for services that are not properly reimbursable or not provided place the entire system in jeopardy and will be prosecuted to the fullest extent of the law.”

The doctor has to repay $702,361 to Medicare and Blue Cross, and up to $100,000 to patients who paid out-of-pocket fees for the massages. To read more about the case, visit www.justice.gov/usao-edar/pr/little-rock-doctor-pleads-guilty-health-care-fraud-admits-22-million-fradulent-billing.