Reporting therapy session fraud
This article shows you how to get a reward for reporting Medicare/Medicaid fraud by reporting therapy fraud by mental health professionals or physical therapy. Below are examples of therapy fraud followed by tips for reporting therapy fraud and how to obtain a reward.
Example of therapy fraud scheme: fraudulent billing individually for group therapy sessions or sessions not provided
One common scheme by those providing group therapy, whether it is counseling or physical therapy, is to bill Medicare or Medicaid for individual therapy when the therapy was provided in a group setting. Obviously, Medicare and Medicaid have different billing rates or reimbursement amounts paid to therapist for group therapy versus individual therapy. For instance, a nursing home or skilled nursing facility might provide physical therapy to 10 residents in a group for one hour (all at one time). However, they bill Medicare for 10 individual therapy sessions. The same is true for mental health professionals providing group therapy or counseling sessions, but billing the government as if they were separate therapy sessions.
Example of therapy fraud scheme: fraudulent billing for more hours of therapy than provided
Another form of therapy fraud is billing for more hours of therapy than what was actually provided. For instance, a therapy session may have lasted 20 minutes, but are billed for 60 minutes.
Example of therapy fraud scheme: fraudulent billing for bingo or social activities as therapy
Another common example of therapy fraud is billing bingo or social events as therapy sessions. For example, a nursing home or skilled nursing facility may hold bingo games or dance lessons for residents on Friday afternoons. However, the bingo or social activity is billed to Medicare as mental health therapy.
A variation of this type of fraud is billing as therapy or mental health services housekeeping or custodial services. In other words, when someone cleans their room or goes to the grocery store, the service is billed as mental health or therapy.
Tips for reporting therapy fraud
You cannot call a Medicare or Medicaid fraud hotline to get a whistleblower reward for reporting therapy fraud. Instead, to apply for a reward for reporting therapy fraud you must use an attorney (on a contingency basis) to file qui tam suit under the False Claims Act.
In addition, your attorney must strictly follow all of the procedures of the whistleblower reward statute to get a reward for reporting cheating or defrauding Medicare or government healthcare programs through therapy fraud.
Moreover, you also need to have specific and detailed evidence of therapy fraud. The government needs your help in uncovering fraudulent billing therapy services. However, because most whistleblower reward applications lack specific proof of fraud (or contain another defect), the government turns away most reward applications. That’s why selecting an experienced attorney that has handled many Medicare fraud cases is very important.
How much reward for reporting a therapy fraud?
The amount of a whistleblower reward for reporting therapy fraud is based upon the amount the government recovers back, and the reward is between 15% and 25% of what the government collects from the therapy company cheating Medicare. For instance, if therapy charges cheat Medicare by $10 million, the amount of the whistleblower reward could be between $1.5 million and $2.5 million.
How to report a therapy fraud
This website (and books written by Mr. Hesch) walk you step-by-step through the entire process of reporting therapy fraud and shows you how to obtain a whistleblower reward.
Mr. Hesch has considerable experience with investigating Medicare fraud against the federal government while working for 15 years at the Civil Fraud Section of the U.S. Department of Justice in Washington, D.C., which is the office with nationwide authority over the whistleblower reward program. He now represents whistleblowers and confidentially reviews information to determine whether and how to report therapy fraud.
The link at the bottom of the page below “Do I have a case” shows you how to ask Mr. Hesch to review your allegations that a therapy company fraudulently billed Medicare or another government healthcare program.