Do It Yourself PT

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The point of going to a physical therapist (PT) is to receive highly specialized care for a particular injury. PTs can prescribe an exercise regimen and work with an injured patient to get them back to normal as soon as possible. Today’s fraud article describes a $14.5 million healthcare fraud scheme perpetrated by the owner of 10 physical therapy clinics located across five states. Dozens of witnesses testified that they may as well have been going to the gym for “Do It Yourself PT.”

The clinic owner had a little help with carrying out the illegal healthcare scheme from his wife, who happened to be the company’s chief financial officer and another employee, the clinic’s vice president of operations. Together, the three submitted more than $18.3 million in fraudulent claims for physical therapy services that were not provided by their clinics located in Texas, Louisiana, Georgia, Memphis and Alabama.

Undercover federal agents, who posed as patients at two of the clinics, busted the illegal operation. (Covert recordings backed up patient and employee claims about suspicious clinic activities.) During the trial, the jury listened to 38 testimonies. Many patients testified during the trial that they didn’t receive one-on-one physical therapy services as indicated on the claims that were paid for by the Department of Labor’s Office of Workers’ Compensation Programs under the Federal Employees’ Compensation Act. (They actually exercised on treadmills, bicycles, elliptical machines and with the Nintendo Wii game without supervision of a PT.)

Apparently, the only type of massage given in the San Antonio clinic was performed by a massage chair. Another patient testified that unlicensed staff directed him to exercise both arms even though he had only injured his left elbow. (They also told him to use the electronic massage chair and the treadmill. Hmmm, not sure how that would help his elbow.) Then, let’s not forget the woman who had a carpal tunnel wrist injury. She was told to walk on a treadmill. (So, you can definitely see where this is going.)

Former employees testified that the Houston clinic had up to 60 patients a day. They also said that many of the employees had no idea what the patients were doing in the main treatment room because they were in the back office treating other patients. Apparently, the former employees were instructed to complete the patient treatment notes using a “cheat sheet” and check with fellow employees and the patients to see what had been completed. (So much for personal patient care.)

The CEO of the physical therapy clinic, his wife and their vice president of operations were all convicted of healthcare fraud after 14 hours of deliberation. (They were all 56-years-old at the time of sentencing, definitely old enough to know better than to try to steal more than $18 million from the government.) The CEO was sentenced to more than 19 years in federal prison, three years of supervised release and he must also pay restitution of more than $14.5 million. His wife was sentenced to serve 10 years behind bars, while their vice president of operations received a sentence of 25 years. (Way to stick it to them judge. The “Do It Yourself” fraud scheme did these three in.)

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, “CEO Gets More Than 19 Years for $18 Million Health Care Fraud Scheme,” released on June 1, 2018.

HOUSTON – The CEO of Team Work Ready (TWR) has received a significant federal sentence for conspiracy, health care fraud, wire fraud and money laundering, announced U.S. Attorney Ryan K. Patrick along with Special Agent in Charge Christopher Cave of the U.S. Postal Service – Office of Inspector General (USPS-OIG), Special Agent in Charge Steven Grell of the U.S. Department of Labor (DOL) – OIG, Assistant Special Agent in Charge Ramsey Covington of IRS-Criminal Investigation (CI), Special Agent in Charge James Werner of the Department of Veterans Affairs (VA) – OIG and Special Agent in Charge David J. Green of the Department of Homeland Security (DHS) – OIG.

A federal jury convicted Jeffrey Eugene Rose Sr., 56, along with his wife – chief financial officer (CFO) Pamela Annette Rose, 56 – and the clinic’s vice president of operations Frankie Lee Sanders, 56, following 14 hours of deliberation on Oct. 17, 2016.

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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.