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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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OIG Enforcement Actions on Therapy Practices

  • Speech and Occupational Therapy Practice Pleads Guilty to Nearly $400K Fraud Scheme in Anne Arundel County

    21 Apr 2023 10:36 AM | Zachary Edgar (Administrator)

    BALTIMORE, MD (April 21, 2023) – Maryland Attorney General Anthony G. Brown today announced that Wellspring Therapy Services, LLC (Wellspring), a speech and occupational therapy practice in Anne Arundel County, pleaded guilty to felony Medicaid fraud in Baltimore City Circuit Court.

    Read more on www.marylandattorneygeneral.gov


  • WFBMC Agrees To Pay U.S. $754,585 Following Documentation Issues Relating To Therapy Services At Wilkesboro Skilled Nursing Facility – February 28, 2023

    28 Feb 2023 10:20 AM | Zachary Edgar (Administrator)

    GREENSBORO, N.C. - Wake Forest University Baptist Medical Center (WFBMC) has agreed to pay the government $754,585 to resolve an overpayment resulting from improper documentation at the Wilkes Medical Center Skilled Nursing Unit (“Wilkes SNU”), announced U.S. Attorney Sandra J. Hairston.

    Read more on www.justice.gov


  • U.S. Attorney’s Office Recovers $2 Million From Autism Therapy Provider For Alleged False Healthcare Claims In District’s Largest TRICARE Settlement

    10 Feb 2023 10:28 AM | Zachary Edgar (Administrator)

    INDIANAPOLIS- The United States Attorney’s Office for the Southern District of Indiana has recovered $2,000,000 for taxpayers as part of a civil settlement with an Indiana autism therapy provider, ABA Programming Inc., Applied Behavior Center for Autism, and its owner, Sherry Michael (“ABCA”). ABCA is a provider of applied behavior analysis services for clients with autism throughout Indiana. The settlement will resolve allegations that ABCA submitted false claims to the TRICARE and Indiana Medicaid programs.

    Read more on www.justice.gov


  • Chaim Mandelbaum, MD Agreed to Pay $127,000 for Allegedly Violating the Civil Monetary Penalties Law for Causing the Submission of Claims for Physical Therapy Services Rendered by an Unlicensed Individual

    21 Nov 2022 10:37 AM | Zachary Edgar (Administrator)

    On November 21, 2022, Chaim Mandelbaum, M.D. (Dr. Mandelbaum), New York, New York, entered into a $127,481.30 settlement agreement with OIG. The settlement agreement resolves allegations that Dr. Mandelbaum caused false claims to be submitted to Medicare for physical therapy services that were rendered by an individual who was not a licensed physical therapist or otherwise authorized to perform physical therapy services payable by Medicare. OIG’s Office of Investigations and Office of Counsel to the Inspector General, represented by Senior Counsels Jonathan Culpepper and Michael Torrisi, collaborated to achieve this resolution.


  • Colorado Springs Company and Owner Pay $400,000 To Resolve Allegations That They Submitted False Claims For Aquatic Therapy

    6 Sep 2022 10:39 AM | Zachary Edgar (Administrator)

    DENVER—The United States Attorney’s Office for the District of Colorado announced today that Dynamic Physical Therapy, LLC (“Dynamic”), a physical therapy company, and its owner, Emad Yassa, have agreed to pay the United States $400,000 to resolve allegations that they violated the False Claims Act by falsely billing federal health care programs for aquatic therapy services.

    Read more on www.justice.gov


  • Montgomery County Skilled Nursing Facility to Pay More than $819,000 to Resolve False Claims Act Liability Arising from Billing of Rehabilitation Therapy

    29 Jul 2022 10:37 AM | Zachary Edgar (Administrator)

    PHILADELPHIA – United States Attorney Jacqueline C. Romero announced that Old Man’s Home of Philadelphia d/b/a Saunders House will pay $819,640 to settle claims that the skilled nursing facility provided medically unnecessary rehabilitation therapy to residents to maximize revenue, and without prioritizing clinical needs.

    Read more on www.justice.gov


  • Cheshire Medical Center Agreed to Pay $1.2 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Therapy Services Not Provided as Claimed

    29 Jun 2022 10:38 AM | Zachary Edgar (Administrator)

    After it self-disclosed conduct to OIG, Cheshire Medical Center (CMC), New Hampshire, agreed to pay $1,217,770.50 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that CMC improperly submitted claims to Medicare Part A for Inpatient Rehabilitation Facility therapy services not provided as claimed, resulting in outlier payments from Medicare to which CMC was not entitled.


  • Hertel & Brown Physical & Aquatic Therapy, Its Two Founders Aaron Hertel and Michael Brown, and 18 Employees Indicted on Fraud Charges

    9 Nov 2021 10:40 AM | Zachary Edgar (Administrator)

    ERIE, Pa. – A physical therapy practice in Erie County, Pennsylvania, and 20 people – 18 of them from northwestern Pennsylvania - have been indicted by a federal grand jury in Erie on charges of conspiracy to commit wire and health care fraud and health care fraud, Acting United States Attorney Stephen R. Kaufman announced today.

    Read more on www.justice.gov


  • Traverse City Physical Therapy And Home Health Practices Resolve Civil Liability For Alleged Healthcare Fraud Against The United States

    3 Nov 2021 10:43 AM | Zachary Edgar (Administrator)

    GRAND RAPIDS – Traverse City-based Defendants Great Lakes Therapy Housecalls, P.C., Great Lakes Home Healthcare Specialists, LLC, and their owner, James A. Harvey, have agreed to pay $450,000 to resolve allegations that they violated the False Claims Act by submitting false claims for reimbursement to the Medicare Program.  This settlement resolves allegations set forth in a complaint filed earlier this year by the United States in the U.S. District for the Western District of Michigan.

    Read more on www.justice.gov


  • Physical Therapy Provider to Pay $4 Million to Resolve Alleged False Claims Act Violations

    28 Oct 2021 10:45 AM | Zachary Edgar (Administrator)

    MINNEAPOLIS – RehabAuthority, LLC, a physical therapy company with operations in Minnesota, has agreed to pay $4 million to resolve allegations that it submitted false claims for payment for outpatient physical therapy services in violation of the False Claims Act. The settlement resolves allegations that, from January 1, 2014, to December 31, 2018, RehabAuthority clinics submitted or caused to be submitted false claims for payment to the government for outpatient physical therapy.

    Read more on www.justice.gov


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