Therapist To Pay $330,000 In Medicare Settlement

, The Connecticut Law Tribune

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A physical therapist who falsely billed Medicare for services that were not provided has settled a civil case with the federal government for nearly $330,000. He has also been sentenced on criminal charges.

Todd Roberts, 47, and his physical therapy practice, Roberts Physical Therapy and Aquatics Therapy in Old Saybrook, were investigated by federal authorities over allegations of false Medicare billing and obstructing a federal audit. Specifically, federal officials claim Roberts regularly billed Medicare for direct, one-on-one physical therapy procedures when such services were not actually provided.

At the clinic, physical therapists and physical therapy assistants would routinely provide services to multiple patients at the same time. Nevertheless, Medicare was billed for each patient as if the physical therapist or physical therapy assistant had provided direct, one-on-one care. For example, patients were routinely left alone to perform exercises in the aquatic therapy pool, with no direct contact with licensed personnel.

Medicare pays only for outpatient therapy services that are provided by qualified personnel. That includes physicians, licensed physical therapists and licensed physical therapy assistants. Medicare does not pay for physical therapy services provided by supportive personnel, such as physical therapy aides, athletic trainers or student trainees.

In addition, according to federal officials, Medicare regulations and policies make it clear that physical therapy services must be thoroughly and accurately documented on the patients' medical chart. The government alleges that Roberts and his physical therapy practice routinely failed to document therapy services.

"This was particularly egregious during the first six months of its operation, when the clinic did not have any documentation at all showing that the services in question were actually provided," stated a news release from the U.S. Attorney's Office in Connecticut.

Officials say the false billing occurred from April 5, 2007 through March 31, 2010. Roberts has agreed to pay $328,828 to settle the civil allegations with the federal government.

Roberts also entered into a six-year Integrity Agreement with the U.S. Department of Health and Human Services that is designed to ensure future compliance with Medicare requirements, including the proper rendering of therapy services and the submission of only valid claims to Medicare for payment.

In addition to the civil allegations, Roberts was also the subject of a criminal investigation.

According court documents, Medicare investigators informed Roberts that they were performing an audit of his practice. Roberts then allegedly instructed an employee to delay the audit by telling auditors that medical records were stored at a nonexistent storage facility. Roberts then rented a storage unit at another facility and used the delay to alter and augment patient records.

Specifically, Roberts and an employee created and added patient progress notes when no notes had been created at the time of service. The notes made it appear as though Medicare beneficiaries had obtained direct, one-on-one service from a licensed physical therapist when, according to authorities, some of the services had been rendered by unlicensed auxiliary personnel.

On September 25, 2012, Roberts waived his right to indictment and pleaded guilty to one count of obstructing a federal audit. He was sentenced earlier this year to three years of probation by Judge Stefan R. Underhill.

Underhill required that Roberts, as conditions of his probation, to comply with the terms of the civil settlement agreement and pay the entire $328,828.

For his civil case, Roberts was represented by Maureen Weaver, of Wiggin and Dana. Weaver did not return calls last week by press time.

The case was investigated by the Office of Inspector General for the Department of Health and Human Services, the Federal Bureau of Investigation, and the Office of the Inspector General for the Department of Veterans Affairs. The case was prosecuted by Connecticut Assistant U.S. Attorneys David J. Sheldon and Richard M. Molot, and Auditor Susan Spiegel.•

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