Legal Services for Occupational Therapists
Health care fraud is rampant in the United States. As a result, the government is prioritizing its investigations and spending more resources in order to catch those who are defrauding patients and insurance companies.
Occupational therapy is just one of the many areas of the medical industry where health care fraud charges may arise. Health care fraud in occupational therapy practices can affect everyone who works in an office and any person in an office may be charged, including the therapists, their assistants and aides, and support staff, such as receptionists.
If you or your occupational therapy office, or practice, have been charged with health care fraud, or are under investigation for allegations of health care fraud you should contact an attorney as soon as possible.
Call 844-239-1234
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What Fraud Statutes Apply To Occupational Therapy Offices?
Occupational therapy offices are covered by a multitude of laws that comprise the country’s health care fraud regime.
Criminal Health Care Fraud (18 U.S.C. §1347)
This statute targets individuals who deliberately execute (or try to) anything that would defraud a health care benefit program of any money or other property under that program’s control.
If convicted of healthcare fraud, defendants face up to 10 years in prison and up to 20 years if someone dies as a result of the fraud, as well as fines up to twice the amount of property received from the scheme.
This is the only criminal statute that deals with criminal fraud, so the rest of the statutes below deal with the many ways you could be prosecuted civilly for health care fraud.
The False Claims Act (31 U.S.C., Chp. 37)
Under this law, medical professionals who purposefully submit fraudulent or false claims to insurance companies in order to receive a payment can be prosecuted.
For example, if an occupational therapist bills a patient’s insurance company for more sessions than were actually provided to that patient, that therapist may be charged with fraud under the False Claims Act.
Violators of False Claims Act face a fine of between $5,000 to $10,000, as well as up to three times the amount the government was defrauded of from the scheme.
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b))
It is illegal for someone to make an intentional payment made to others as a reward for patient referrals or the generation of business involving any item or service payable by government-funded healthcare programs.
So, if an occupational therapist pays another doctor to refer patients covered by Medicaid to come to their specific practice, this would be a violation of the Anti-Kickback Statute.
If you are found guilty of violating the Anti-Kickback statute you face fines of up to $25,000, a prison sentence of up to 5 years, or a combination of both.
The Physician Self-Referral law (Stark Law) (42 U.S.C. § 1395nn)
The Stark Law is aimed at punishing those doctors who refer patients to receive specialized medical care from any facility or business that the doctor, or any member of the doctor’s immediate family, has some financial interest in.
For example, if an occupational therapist recommends that their patient needs some type of pain management and refers them to a pain clinic owned by their wife, this would be in violation of the Stark law.
Other statutes that if violated would be considered health care fraud includes the Exclusion Statute (42 U.S.C. § 1320a-7).
Health Care Fraud and Occupational Therapy in the News
Occupational Therapist Owner of TSM Sentenced for Making False and Fraudulent Statements Related to Health Care Benefits
In April 2018, Jose Penaranda Tan was sentenced to 12 months and 1 day in prison for his role in a health care fraud scheme involving Therapeutic Services of Morristown, a clinic he owned and operated.
In addition to his prison sentence, Tan has been ordered to pay restitution to the various insurance companies he defrauded. The amount that has not yet been decided by the court.
At the time of his guilty plea, Tan admitted that over the course of about two years he submitted, or caused others to submit, about 10,000 false or fraudulent claims to both public and private insurance companies.
Tan ordered his staff to bill for individual therapy sessions when in reality he was providing therapy in group sessions. Individual sessions yield a higher rate of reimbursement that group therapy sessions, because there are more claims being filed.
In the course of his practice, he also allowed non-licensed assistants to practice therapy and would bill insurances for the services under the names of former therapist employees.
For more information and the full Department of Justice (DOJ) press release, click this link or copy and paste the URL below.
Licensed Occupational Therapist Pleads Guilty to $2.6 Million Medicare Fraud Conspiracy
In October 2016, Keith Canlapan pled guilty in connection with his role in a $2.6 million Medicare fraud scheme that involved billing for occupational therapy services he did not actually provide to patients.
Canlapan admitted that while was employed as a licensed occupational therapist he regularly billed Medicare for services he had not provided. The patients were actually provided with massages and acupuncture – neither of which are eligible for reimbursement under Medicare.
Canlapan further admitted that when those patients were being treated, he was not actually present. Instead, he was either out of the country or at his other places of work. From October 2009 to about December 2012, Canlapan used this scheme to fraudulently bill Medicare for $2,669,618, of which Medicare paid out $1,860,786.
One of his co-defendants, Simon Hong, received 63 months in prison for his role in this scheme. His case is discussed in the next press release.
For more information and the full DOJ press release, click this link or copy and paste the URL below.
Call 844-239-1234
for a Free Confidential Consultation
California Clinic Owner Sentenced to 63 Months in Prison for Role in Occupational Therapy Fraud Scheme
Simon Hong pled guilty to one count of conspiracy to commit health care fraud on December 15, 2016.
In March 2017, Hong was sentenced to 63 months (just over five years) in prison and ordered to pay $2.4 million in restitution.
Hong admitted that he owned JH PHysical Therapy Inc., a clinic that provided occupational, physical and speech therapies. Further, he admitted that he billed Medicare for occupational therapy services that had not been provided, and which were not covered by Medicare.
In addition, Hong admitted that he ordered his co-conspirator therapists to falsify medical records in order to make it appear as if the services billed had been actually provided. He then funneled around 87% of the proceeds from the scheme to himself.
As a result, Hong received about $2.4 million in payouts from Medicare.
In a previous health care fraud case, Hong had already been sentenced to 121 months (about 10 years) in prison.
For more information and the full DOJ press release, click this link or copy and paste the URL below.
Detroit Occupational Therapist Pleads Guilty to Medicare Fraud Scheme
In August 2011, Carol Grant, a licensed occupational therapist in the Detroit area, pled guilty to one count of conspiracy to commit health care fraud.
Grant was hired by Jos Campau Physical Therapy in 2005 to create and sign falsified documents and occupational therapy files. Grant also admitted to creating patient evaluation forms for Medicare beneficiaries that she never saw or met. She also signed fraudulent discharge paperwork.
In addition, Grant hired an uncertified occupational therapy assistant to create false notes for occupational therapy visits that the assistants were purported to have performed. Over the course of this two-year scheme, Grant admitted to submitting $897,512 worth of fraudulent claims to Medicare.
For more information and the full DOJ press release, click this link or copy and paste the URL below.
https://www.justice.gov/opa/pr/detroit-occupational-therapist-pleads-guilty-medicare-fraud-scheme
Call a Trusted Healthcare Attorney Before It Is Too Late!
Call a Trusted Healthcare Attorney Before It Is Too Late!
If you are an occupational therapist or work for one and you have been accused of violating the healthcare fraud laws, contact an experienced health care defense attorney as soon as possible.
An experienced healthcare attorney will be able to guide and advise you through every step of the investigation and help you to avoid trial. They can advocate for your rights and interests to the fullest extent.