In Cherry Hill, NJ there was a Chiropractor and his father who is a doctor admitted to the conspiracy to commit Medicare fraud. This fraud was from seeing patients who were not qualified to receive physical therapy. After the McGraths pleaded guilty to Medicare fraud, they and their practice, Atlantic Spine & Joint Institute, agreed to pay part of the civil settlement of $1.78 million to resolve the Medicare fraud allegations made against them. Per the court filings, the McGraths employed unlicensed physical therapists who treated Medicare patients. However, per Medicare, the only way their clients can be approved to be treated in chiropractic care is by a licensed chiropractor.

            When the billing was done, they used Dr. McGrath as the provider who performed the physical therapies. I would have reported this when I noticed that he was the provider that was set on the billing to Medicare. I would implement background checks through the compliance and regulations departments to ensure that there was nothing that was missed in the background checks when hiring other providers, etc. Billing should also report any suspicious coding findings to the compliance department ASAP.

Reference

·      Department of Justice. 2017, June 13. Cherry Hill Doctor and Son Admit Defrauding Medicare, Agree to $1.78 Million Settlement.