Prison Therapy

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To become a physical therapist, an individual must earn a professional degree, which is usually a doctorate in physical therapy. Once the degree is obtained, then states require a license to legally work as a physical therapist. (All of those hours spent learning and in clinical rotations reassure the patient that their provider is qualified to treat them.) A North Haledon, New Jersey doctor committed Medicare fraud by allowing more than 150,000 physical therapy sessions (yes, you read that right) to be performed by unlicensed and unqualified personnel.

Physical therapists help patients to retrain injured or debilitated muscles by moving, stretching, exercising and strengthening various parts of the body. (If you are injured, you definitely don’t want someone who doesn’t know what they are doing moving your sore body parts every which way, increasing the potential for another injury.)

For more than nine years, the doctor with offices in Paterson, Passaic and Elizabeth, allowed individuals without the proper training and certifications to provide physical therapy services to his patients. (The number of treatments provided per month averages out to about 1,340. With a number that high, the odds of injury were high.)

 The doctor billed Medicare and private insurers for physical therapy services he provided, although his unqualified and uncertified employees were the ones doing the work. Medicare and private insurance companies require that physical therapy services only be performed by individuals who are trained and certified. (The doctor’s fraudulent billing practices enabled him to collect more than $3 million for the 150,000 treatments.)

The 60-year-old doctor from New Jersey pleaded guilty to one count of healthcare fraud for defrauding Medicare and private insurance companies out of $3 million. He received a three-year prison sentence for his crime plus three years of supervised release and must pay $3 million in restitution. (The judge must have liked the number three.)

Physical therapy is a beneficial treatment that can restore individuals to good health if performed correctly. (With more than 650 muscles and 250 bones in the human body, you want a physical therapist who knows which muscle to move where.) If physical therapy treatment goes wrong, the patient faces a longer recovery time and the physical therapist could face a costly and career-damaging malpractice claim. (Thankfully, today’s fraud article doesn’t state that anyone was injured during the 150,000 treatments, but it looks like the doctor is now going to receive some very specialized reform therapy from the justice system while behind bars.)

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, Doctor Gets Three Years In Prison For Billing Medicare, Other Insurers $3 Million For Therapy Services Performed By Unqualified Personnel,” released on March 26, 2018.

NEWARK, N.J. – A doctor with offices in Paterson, Passaic, and Elizabeth was sentenced today to 36 months in prison for defrauding Medicare and private insurance companies out of $3 million by billing them for over 150,000 physical therapy sessions that were performed by unlicensed and unqualified personnel, U.S. Attorney Craig Carpenito announced.

Anthony J. Enrico, 60, of North Haledon, New Jersey, previously pleaded guilty before U.S. District Judge Kevin McNulty to an information charging him with one count of health care fraud. Judge McNulty imposed the sentence today in Newark federal court.

 

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.