Article Highlights Excessive Medicare Billings

By Martin & Jones on March 18, 2018

The New York Times recently reported on Medicare billing data which was released over the opposition of the American Medical Association and other industry groups. The data revealed that a single practitioner in Brooklyn in 2012 submitted billings for $4.1 million from Medicare. The Brooklyn practice of Wael Bakry, a physical therapist, reported seeing 1,950 Medicare patients in 2012. On average, the practice was paid by Medicare for 94 separate procedures for each patient.

Federal regulators have increasingly targeted unscrupulous practitioners who routinely bill Medicare for unnecessary treatments or procedures they never perform. Those practices are often easier to get away with in physical therapy than in specialties such as oncology or cardiology. Medicare paid physical therapists working in offices $1.8 billion in 2012 alone, the 10th-highest field among 74 specialties.

Enforcement efforts by federal authorities are yielding results. In 2011, a Brooklyn physical therapist pleaded guilty to submitting nearly $12 million in false and fraudulent claims to Medicare over a period of five years. In 2013, the owner of a Brooklyn medical clinic was sentenced to 15 years in prison for her role in a $77 million fraud in which patients were paid cash kickbacks to induce them to remain silent about services, including physical therapy, that were not provided but were billed to Medicare.

Individuals with knowledge of fraudulent or unscrupulous billing practices should speak with an attorney knowledgeable of False Claims Act cases. Individuals who report fraud (“whistleblowers”) stand to receive significant payments in the event fraud on the government is proved and a recovery is obtained.