Honesty Makes a Huge Difference

Physiotherapist giving physical therapy to senior male patient in clinic

Physical therapy (PT) can make a huge difference in someone who is suffering from an injury or debilitating condition. It can improve a patient’s mobility issues, while helping them to also avoid invasive surgeries, unnecessary prescription medications and expensive doctor bills. Fortunately, the Medicare program sees the benefit in covering PT, so that beneficiaries can get back on their feet as soon as possible. A doctor and his son, who operated a spine and joint medical practice in two states, illegally billed for physical therapy sessions that were performed by unqualified employees. Their Medicare fraud scheme has left them with a hefty bill of $1.78 million plus interest due to the government healthcare program to resolve the allegations against them.

The doctor and his son had two practices, one in New Jersey and another one in Pennsylvania. Over five years, the two locations employed unlicensed and untrained people to provide physical therapy to their Medicare patients when the doctor was not in the office. (Medicare requires that physical therapy must be provided by a doctor or a trained physical therapist under their supervision.) Following the unsupervised therapy, the office would submit bills to Medicare fraudulently stating that the son, or chiropractor, was the PT provider. (As you might guess, that was not the case.)

Their lengthy scam was abruptly halted when the practice’s former billing manager blew the whistle and filed a claim under the False Claims Act. (The federal law basically says that anyone who defrauds a government program is in big trouble and they will be prosecuted to the full extent of the law.) Under this law, the former employee also gets to share in any monetary recovery. (That is a huge incentive to expose fraudulent acts that undermine federal programs.)

The 65-year-old doctor and his 47-year-old son admitted their roles in the conspiracy to defraud Medicare by using unqualified employees. They both pleaded guilty to conspiracy to commit healthcare fraud. They each face a maximum of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. They are scheduled to be sentenced. The pair also agreed to pay $1.78 million plus interest to the federal government in a related civil settlement. (That will definitely hit them in the wallet.)

On the bright side, it doesn’t appear that any patients were harmed as a result of the unsupervised services and the whistle blower will receive around $338,200 from the settlement proceeds along with her attorney’s fees. (See, it really does pay to be honest.) Congratulations to the whistleblower and the New Jersey U.S. Attorney’s Office’s Health Care and Government Fraud unit for stopping this Medicare fraud scheme from harming any patients and stealing any more funds undeserved by this father-son duo.

Today’s “Fraud of the Day” is based on an article entitled, Cherry Hill Doctor, Son Admit to Medicare Fraud, Authorities Saypublished by Cherry Hill Patch on June 13, 2017.

CHERRY HILL, NJ — A father and son who are both in the medical field have admitted to their roles in a conspiracy to defraud Medicare by using unqualified people to give physical therapy to Medicare recipients, Acting U.S. Attorney William E. Fitzpatrick said Tuesday evening.

Robert Claude McGrath, 65, and his son, 47-year-old Robert Christopher McGrath, both of Cherry Hill, each pleaded guilty to separate informations charging them each with conspiracy to commit health care fraud. Robert Claude McGrath is a doctor, and Robert Christopher McGrath is a chiropractor. 

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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.