At a Higher Risk

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Physical therapists are at a higher risk for malpractice claims due to the nature of their work. Some common reasons for malpractice suits include failure to properly supervise a patient, improper technique, injury from manipulation, burns from hot packs or stretching and exercise injuries. Today’s fraudster, a podiatrist from North Haledon, New Jersey, didn’t get hit with any malpractice suits, but something worse – a prison sentence. He committed Medicare fraud by billing for more than 150,000 physical therapy sessions that were performed by unqualified staff members. (Think of the sheer number of patients that were put at a higher risk for injury because of this man’s greed.)

Each state has rules on delegating duties to an unlicensed person performing tasks within the scope of physical therapy. It’s a general rule that a licensed professional cannot delegate responsibilities when they know the person they are delegating to is not qualified to perform the duties. (There’s nothing wrong with the unlicensed assistant observing treatment, but they should not treat patients.)

The podiatrist from North Haledon had multiple offices in Paterson, Passaic and Elizabeth. For more than nine years, the man submitted claims to Medicare and other insurance providers for physical therapy services he claimed he provided to his patients. (He filed claims for more than 150,000 patients and collected approximately $3 million from government and private insurers.) Except, he didn’t provide the services. He delegated the responsibilities to unqualified and uncertified staff members. (Medicare obviously requires that the person performing physical therapy possesses the appropriate credentials.)

The New Jersey podiatrist pleaded guilty to healthcare fraud, admitting that he directed unlicensed and unqualified personnel to perform physical therapy. The 60-year-old foot doctor received a three-year prison sentence, three years of supervised release and was ordered to pay $3 million in restitution. (One year for each million he stole. The judge in today’s case liked the number three.)

Congrats to New Jersey’s Health Care and Government Fraud Unit for stopping this podiatrist from putting any additional patients at risk. The office, which has recovered more than $1.38 billion in healthcare fraud and government fraud settlements since inception, has effectively put an end to this man’s ruse and eliminated any further risk.

Today’s “Fraud of the Day” is based on an article entitled, Paterson doctor gets three-year prison sentence for $3 million insurance fraud,” published by Paterson Times on March 26, 2018.

A doctor from North Haledon with an office in Paterson received a three-year prison sentence on Monday for defrauding Medicare and private insurance firms out of $3 million by billing for physical therapy sessions that were performed by unqualified staff members.

Anthony J. Enrico, 60-year-old, pleaded guilty on a single count of healthcare fraud, for billing 150,000 physical therapy sessions that were performed by unlicensed and unqualified personnel.

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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.