Eli's Rehab Report

Tennessee PT Clinic Gets Nailed on Anti-Kickback Statute

WASHINGTON, D.C. -- The HHS Office Of Inspector General (OIG) posted its most recent criminal enforcement actions last month, and a physical therapy clinic's blatant wrongdoing appeared at the top of the list.

In Tennessee, the owner of a physical therapy company pled guilty to violating the anti-kickback statute, according to an OIG release. The owner, a woman left unnamed, was sentenced to four months in prison and ordered to pay $173,000 in restitution.

Details: The owner paid kickbacks to doctors based on the percentage of her profits for the patients referred to her company for physical therapy services.

The criminal investigation also revealed that the woman employed unlicensed physical therapists, billed for more therapy than therapists provided, and prepared fraudulent medical records for a Medicare audit, OIG said.

SANTA MONICA, Calif. -- A fitness company that's been a professional athlete's best-kept secret is coming out of the woodwork and offering business opportunities for physical therapists.

VERT Worldwide Inc. hopes to sell 10 VERT Fitness Centers during the next four years in each of the top 32 U.S. sports markets, according to a press release.

VERT is offering two businesses to franchisees: a fitness facility and a physical therapy practice. Both include a 5,000-square-foot VERT Peak Fitness Center with equipment and programs that use a combination of computer-controlled exercise machines, isokinetic exercises, and trainer-supervised appointment-only workouts, VERT said.

Background: The VERT (velocity enhanced resistance training) system eliminates inertia associated with weights and allows the type-two fast-twitch muscle fibers to do high-speed training, the press release said. "Using computer technology, VERT analyzes the speed, position and resistance of muscles 16,000 times per second throughout the entire range of motion."

"VERT trains the nervous system to contract muscles fast. The faster the muscles contract, the faster the particular limb moves. The faster the limb moves, the better that person can functionally perform," said Ed Torkelson, founder and president of VERT Worldwide Inc.

LEESBURG, Fla. -- In a June release, the HHS Office of Inspector General (OIG) issued a review of rehab services at the Florida-based Avante at Leesburg skilled nursing facility (SNF), and the overpayment bill is big.

Findings: A medical review of the 100 sampled claims showed that 20 included medically unnecessary or improperly billed skilled services, according to the OIG report. As a result, the OIG estimated that Medicare overpaid Avante at least $708,086 for services that did not meet Medicare requirements.

The OIG recommended that Avante refund the Medicare program $708,086 in overpayments, in addition to taking precautions to prevent overpayments.

Avante disagreed with the medical reviewers' determination that 30 Resource Utilization Groups be denied or downcoded, but the OIG stands by its findings and recommendations. To read the full report, visit www.oig.hhs.gov/oas/reports/region6/60600107.pdf.