Carolina Physical Therapy and Sports Medicine, Inc. To Pay $790,000 to Resolve False Billing Allegations
COLUMBIA, South Carolina ---- United States Attorney Sherri A. Lydon announced today that the United States Attorney’s Office for the District of South Carolina has resolved claims of health care fraud with Carolina Physical Therapy and Sports Medicine, Inc. (“Carolina PT”). Carolina PT was a chain of nine physical therapy practices headquartered in Columbia, South Carolina, with practice locations in Columbia, Irmo, Lexington, Sumter, and Mount Pleasant.
The United States contended that Carolina PT knowingly submitted claims to Medicare and TRICARE for services provided to multiple patients simultaneously as though the services were being provided by a physical therapist or physical therapist assistant to one patient at a time. As a result, Carolina PT received higher reimbursements than it would have if it had accurately represented the services. Additionally, the United States contended that Carolina PT knowingly submitted claims to Medicare and TRICARE for services provided by physical therapy assistants who were not supervised by a physical therapist, as required. Finally, the United States contended that Carolina PT knowingly submitted claims for attended electrical stimulation services when those services were in reality not attended by a licensed therapist or assistant and should have been billed as a lower cost unattended electrical stimulation service.
This settlement resolves a lawsuit originally filed in the United States District Court for the District of South Carolina by Hilary Moore, a former employee of Carolina PT, under the qui tam or whistleblower provisions of the False Claims Act, which permit private citizens to bring lawsuits on behalf of the United States and share in any recovery. Moore will receive $142,200 from the settlement, and her attorneys will recoup fees from Carolina PT in the amount of $38,000.
“Medical billing fraud drives up the cost of healthcare and diverts critical resources from federal healthcare programs,” U.S. Attorney Lydon said. “Whistle blower suits, like this one, are one of the government’s most effective tools at detecting fraud and protecting the integrity of our burdened healthcare system. The U.S. Attorney’s Office for the District of South Carolina will continue to pursue companies and providers that defraud federal health care programs.”
“Carolina PT inflated bills sent to federal health programs, the government contended,” said Derrick L. Jackson, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services. “People who depend on medical care through these programs, and taxpayers who provide the funding, deserve much better. We will continue to work with the U.S. Attorney and other law enforcement partners to safeguard these services.”
“I applaud the Department of Justice and the U.S. Attorney for their continued efforts to hold health care providers accountable to the American taxpayer,” said Vice Adm. Raquel Bono, director of the Defense Health Agency. “The efforts of the Department of Justice safeguard the health care benefit for our service members, veterans and their families. The Defense Health Agency continues to work closely with the Justice Department, and other state and federal agencies to investigate all those who participated in fraudulent practices.”
The case was investigated by the U.S. Attorney’s Office for the District of South Carolina, the Defense Criminal Investigative Service (“DCIS”) and the U.S. Department of Health and Human Services Office of Inspector General (“HHS-OIG”). The civil settlement was reached by Assistant United States Attorney Beth Warren of the Columbia office.
The claims resolved by this settlement are allegations only and there has been no determination of liability.
If you suspect Medicare or Medicaid fraud please report it by phone at 1-800-447-8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov.