What is particularly worth noting in this news item is that the employee PT was involved in fraudulent billing, despite the fact that payments were not being made directly to her. This should help to further dispel the myth that an employment relationship acts as some type of "shield" against liability for billing fraud.
From Medical News TODAY:
Framingham Woman Pleads Guilty To Health Care Fraud
Reports U.S. Attorney
22 Jul 2006
A physical therapist pleaded guilty earlier this week in federal court to a charge of health care fraud in connection with her causing Medicare to be billed for at least $55,000 worth of physical therapy she either did not provide or provided incompletely to patients.
United States Attorney Michael J. Sullivan and Joseph C. Moraski, Special Agent in Charge of the Department of Health and Human Services, Office of the Inspector General for New England, announced that HO LING LAI, age 38, of Framingham, Massachusetts, pleaded guilty on Tuesday, July 18, 2006 before U.S. District Judge Reginald C. Lindsay to a one-count Information charging her with knowingly and willfully committing health care fraud.
At the plea hearing, the prosecutor told the Court that, had the case proceeded to trial, the evidence would have proven that LAI worked as a physical therapist for three different visiting nurse associations at the same time. In the course of her employment, LAI purported to be providing physical therapy to different patients of the different visiting nurse associations at the same time, on the same day, but in different towns. LAI knew that the time sheets on which she recorded the times of these visits would be used to bill the Medicare program, thereby causing it to pay money for services which were either not rendered or which were rendered in an incomplete manner. The visiting nurse associations billed the Medicare program for no less than $55,000 based on LAI's false representations.
Judge Lindsay scheduled sentencing for November 27, 2006 at 2:00 p.m. LAI faces a maximum sentence of 10 years in prison and a $250,000 fine. The investigation was conducted by the Department of Health and Human Services, Office of the Inspector General. It is being prosecuted by Assistant U.S. Attorney Thomas E. Kanwit of Sullivan's Health Care Fraud Unit.