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PTs Charged With Medicare/Medicaid Fraud

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Vol. 10 •Issue 13 • Page 7
PTs Charged With Medicare/Medicaid Fraud

Michigan Attorney General Jennifer M. Granholm announced on May 1 that she has charged two physical therapy facilities and their owners with 66 felony counts of Medicare and Medicaid fraud.

The charges were filed in the 76th Judicial District Court in Mt. Pleasant.

Granholm alleges that beginning in December 1999 and continuing through July 2000, the therapists conspired to bill Medicare and a Medicaid HMO for outpatient physical therapy services that were never provided.

Babubhai Rathod, PT, 32, owner of Emerald Physical Therapy, P.C., in Mt. Pleasant, was charged with:

• Eight counts of falsifying medical records;

• Four counts of health care fraud (making a false claim);

• Two counts of fraud or larceny more than $1,000;

• One count of conspiracy to commit fraud or larceny.

Emerald Physical Therapy, as a corporation, faces the same charges.

Ram Cxand Arora, PT, 77, owner of Birmingham Rehabilitation and Physical Therapy Center, Inc., Detroit, was charged with:

• Four counts of fraud or larceny more than $1,000;

• Thirteen counts attempted fraud or larceny more than $1,000;

• One count conspiracy to commit fraud or larceny.

Birmingham Rehabilitation and Physical Therapy Center, as a corporation, faces the same charges. "When health care providers cheat the state's Medicaid system, they're cheating every taxpayer who funds it," Granholm said.

The Investigation

An investigation by Granholm's Health Care Fraud Division together with the FBI, Office of the Inspector General, Health and Human Services, United States Postal Inspection Service, and United Government Services, LLC, revealed the alleged insurance billing scheme in which Rathod conspired with Arora to bill Medicaid for "phantom" treatments to the residents of two northern Michigan nursing homes that had been closed for more than year.

Granholm alleges that between April and July 2000, Rathod ordered Emerald employees to create physical therapy charts for residents of White Oaks Manor, a 28-bed facility in Mio that was closed by the State on Jan. 12, 1999. He also ordered his employees to create charts for residents of Apple Wood Manor, a 30-bed facility in McMillan that was closed March 10, 1999. Claims for each resident were back-dated to appear that services had been provided while the facilities were operating; the physical therapy services had never been provided.

According to the complaint, Rathod en.tered into an agreement with Arora to have his clinic, Birmingham Rehabilitation, submit the false Emerald billings as if the physical therapy services had been performed by Birmingham.

The investigation also revealed that between December 1999 and July 2000, Emerald/Rathod billed Community Care Plan, a Medicaid HMO, for services it did not provide to its other clients. According to the complaint, on several different occasions Rathod billed the HMO for two .sessions of electrical stimulation therapy .when he only provided a single .session of the therapy.

Penalties for the various charges are:

• Intentionally placing false information on a medical record or chart, punishable by four years in prison and/or $2,000 fine;

• Health care fraud, making a false claim, punishable by four years in prison and/or $50,000 fine;

• Fraud/larceny by false pretenses ($1,000 or more, but less than $20,000), punishable by five years in prison and/or $10,000 fine or three times the value of the money involved, whichever is greater;

• Attempted larceny/fraud, punishable by two years in prison;

• Conspiracy to commit larceny/fraud, punishable by five years in prison and/or $10,000 fine or three times the value of the money involved, whichever is greater, plus $10,000 additional fine.




     

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