by Ben Vernia | January 21st, 2018
On January 19, the Department of Justice announced that San Diego-based Scripps Health had agreed to pay $1.5 million to settle a whistleblower’s allegations that the health care company submitted claims for physical therapy services that were false because the therapists providing the services lacked billing privileges. According to DOJ’s press release:
Scripps Health (Scripps), a health care system based in San Diego, California, has agreed to pay $1.5 million to resolve allegations that it violated the False Claims Act by charging federal health care programs for physical therapy services that were rendered by therapists who did not have billing privileges for these programs and were not supervised by an authorized provider, the Justice Department announced today.
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Medicare and TRICARE limit billing privileges to enrolled providers. Services from unenrolled providers can be billed as “incident to” the services of an enrolled physician, but only if the physician provided direct supervision. The United States alleged that Scripps billed Medicare and TRICARE for physical therapy services provided by therapists without billing privileges and without the appropriate supervision by a physician.
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The whistleblower in the case will receive $225,000 (a 15% relator’s share), the Department announced.
