Legal Services for Massage Therapists
Our health care attorneys have been protecting the interests and defending the rights of health care practitioners for years. Our experience providing legal counsel to health care professionals means we understand what is at stake with any administrative, compliance related or criminal investigation.
Criminal defense is a large part of our practice specifically defending against health care fraud charges. As efforts to curb healthcare fraud rise, the importance of quality counsel remains imperative. We have devoted our careers to defending clients at risk of losing everything to a criminal conviction. Our passion for justice rests on the belief that everyone deserves a second chance, and that no one should spend their lives paying for a past mistake.
If you are a massage therapist concerned about involvement in healthcare fraud, do not hesitate to contact us for a risk-free consultation today. We are available to provide 100% confidential counsel regarding your circumstances, whether you are currently embattled in criminal proceedings or simply want to protect yourself from future liability.
In the meantime, we have provided answers to some of the most common questions our clients ask below, in order to provide you with the basic understanding you need to decide your next steps.
What Types of Healthcare Fraud Charges Do Massage Therapists Face?
Massage therapists involved in healthcare fraud schemes have faced charges under the False Claims Act and the Federal Healthcare Fraud Statute, the Federal Mail and Wire Fraud Statutes, among many others. They have also faced state charges under similarly adopted statutes, as well as under state laws regarding related conduct.
Examples of possible penalties include:
- False Claims Act violations can result in excessive fines and up to five years in prison.
- Federal Healthcare Fraud Statute violations can extend up to ten years in prison.
- Mandatory sentencing guidelines, which do not permit a judge to limit the minimal sentence those guidelines may impose upon you.
What Types of Behaviors Expose Massage Therapists to Criminal Liability?
Essentially, taking part in the fraudulent representation of information in a healthcare context exposes you to both civil and criminal healthcare fraud liability, even if you are not a licensed medical professional.
The most common way in which massage therapists participate in a healthcare fraud scheme is by providing services which are then fraudulently billed to insurance providers.
Here is how it works. While massage therapy is widely regarded as a beneficial service, it is also largely considered optional by the mainstream medical industry. Accordingly, insurance companies do not tend to provide reimbursements for massage therapy services, due to the fact that they are considered a low medical priority.
This bar of coverage is attributable to many factors, including the level of training massage therapists are required to undergo, and the degree of scientific research supporting its role in treating medical conditions.
Hence, healthcare fraud furthered by massage therapists often involves billing insurance companies for services that are covered, like physical therapy, when in fact massage therapy is provided instead.
A massage therapist might take part in this type of scheme to get around the fact that massage therapy is not covered by insurance. This is because patients are more likely to agree to covered services, which they only have to pay for a small portion of.
Massage therapists might be motivated by additional or alternate incentives, such as fee arrangements with co-conspirators or other perks, including the reduction or waiving of overhead costs in exchange for cooperation with the scheme.
A variation on the type of fraud detailed above occurs when physical therapy or other services are performed, but they are performed by massage therapists rather than licensed professionals.
This constitutes fraud because insurance coverage is not only limited to certain types of treatments, but to certain types of medical professionals as well. Most insurers will not extend coverage to an eligible service unless it is provided by an eligible professional.
Whatever form the fraud takes, massage therapists involved in a healthcare fraud scheme often align themselves with a licensed medical professional who is seeking to avoid the time expenditure of seeing patients. This is done by outsourcing work to unlicensed therapists, and then billing for it as though he provided their services himself.
Your job is to perform the service the licensed medical professional is claiming to perform, whether it is a massage fraudulently billed as physical therapy or an actual physical therapy service you are not by insurance standards qualified to perform.
This enables a licensed professional to collect insurance reimbursements in connection with your work, which he may or may not share with you. Whatever the agreement, this type of scheme allows a licensed professional to bill for far more claims than he could individually provide.
It is important to emphasize however that you do not need to align yourself with a licensed professional to take part in a healthcare fraud scheme. You might participate in or lead a scheme which fraudulently uses the identity of a licensed medical professional to sign off on reimbursement claims.
Such a scheme does not require the conscious involvement of a medical professional, but might give rise to additional criminal charges, such as Identity Theft or Aggravated Identity theft, with the latter imposing a mandatory two-year prison sentence.
As a final important note, deliberately executing a fraudulent scheme with another person, whether or not that person is a licensed professional, can constitute a conspiracy. Where false claims are submitted to a government benefit program like Medicare, you could be charged with Conspiracy to Defraud the United States.
If convicted of these charges, additional sentencing will be added to any sentencing you face in connection with other charges.
How Have Massage Therapists Been Penalized for Healthcare Fraud in the Past?
There are many cases involving healthcare fraud committed by or with massage therapists. Below are just a few examples:
In Texas, owners of a Wound Care Institute were charged with False Claims Act violations for submitting false claims for reimbursement to Medicare. The claims sought reimbursement for lymphatic drainage services covered under Medicare. Medicare rules require them to be done by licensed physical therapists, which they were not done by.
When a physician who also provides lymphatic drainage services learned of this, he filed a whistleblower lawsuit under the False Claims Act. The suit resulted in a $4.3 million dollar settlement. He received 19% of it. The settlement barred the defendants from participating in any federal healthcare benefit program for a ten-year period.
Kawai Ary-Berry, a licensed massage therapist who was convicted of healthcare fraud in 2010, billed the Federal Worker’s Compensation Fund for unperformed services, and coded her services as physical therapy. She got 78 months in federal prison and 3 years of supervised release, and a charge of $1.6 million dollars in victim restitution.
In Chicago, massage therapist Viktor Danchuk was charged with aggravated identity theft and healthcare fraud for his part in a scheme that defrauded $6.5 million dollars from private auto and healthcare insurers. The scheme involved four other defendants, including two medical claims billers, a personal trainer, and a physical therapist.
The defendants fraudulently used the identity of licensed medical professionals to submit reimbursement claims for medical services never actually provided. Danchuk provided free massages to friends and family members of the schemers, who in exchange allowed their insurance deductibles to be exhausted.
In addition to providing the incentivizing free massage sessions, Danchuk personally profited off of the scheme. While Danchuk was only recently indicted, he could face a mandatory sentence of two years in prison if convicted on the aggravated identity theft charge. A healthcare fraud conviction could add a potential ten years to that sentence.
In Arkansas, two massage therapists were involved in a healthcare fraud conspiracy that fraudulently billed massage therapy services like physical therapy services. They contracted with the owner of a clinic to perform services on physical therapy patients they referred, exchanging a portion of their profits for low rent and overhead.
Facing up to five years in federal prison with three years of probation for his role in the scheme, Billy Marc Young, one of the two therapists, accepted a plea deal that required him to testify against the clinic owner, a licensed physician. His plea deal also imposed a year in federal prison, a $267,871 restitution payment and the forfeiture of $311,130.
How Can I Protect Myself?
The best way to protect yourself from criminal liability is to retain the counsel of a skilled criminal defense attorney. Our criminal attorneys are available for risk-free consultations to give you the specific guidance you need to decide your next steps.