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Physical therapy practice with Sumter location settles suit

Whistleblower brought claims of Medicare bill inflation against Carolina Physical Therapy

BY KAYLA ROBINS
kayla@theitem.com
Posted 5/10/19

A Columbia-based physical therapy practice with a location in Sumter has settled with the U.S. Attorney's Office in South Carolina on claims of health care fraud, agreeing to pay $790,000.

Hilary Moore, a former employee of Carolina Physical …

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Physical therapy practice with Sumter location settles suit

Whistleblower brought claims of Medicare bill inflation against Carolina Physical Therapy

Posted

A Columbia-based physical therapy practice with a location in Sumter has settled with the U.S. Attorney's Office in South Carolina on claims of health care fraud, agreeing to pay $790,000.

Hilary Moore, a former employee of Carolina Physical Therapy and Sports Medicine, filed the original lawsuit as a whistleblower in the U.S. District Court for South Carolina under the False Claims Act.

Carolina PT was a chain of nine physical therapy practices headquartered in Columbia with locations in Columbia, Irmo, Lexington, Sumter and Mount Pleasant, according to the office of South Carolina U.S. Attorney Sherri A. Lydon.

"Carolina PT inflated bills sent to federal health programs, the government contended," said Derrick L. Jackson, special agent in charge of the Office of Inspector General for the U.S. Department of Health and Human Services. "People who depend on medical care through these programs and taxpayers who provide the funding deserve much better."

It was contended that Carolina PT knowingly submitted claims to Medicare and TRICARE for services provided to multiple patients simultaneously as though the services were being provided by a physical therapist or physical therapist assistant to one patient at a time. As a result, Carolina PT received higher reimbursements than it would have if it had accurately represented the services.

Additionally, the United States contended the practice knowingly submitted claims to Medicare and TRICARE for services provided to physical therapy assistants who were not supervised by a physical therapist, as required.

The last claim was that Carolina PT knowingly submitted claims for attended electrical stimulation services when those services were not attended by a licensed therapist or assistant and should have been billed as a lower cost unattended electrical stimulation service.

"Medical billing fraud drives up the cost of health care and diverts critical resources from federal health care programs," Lydon said. "Whistleblower suits like this one are one of the government's most effective tools at detecting fraud and protecting the integrity of our burdened federal health care programs."

As part of the settlement and whistleblower law, Moore will receive $142,000, and her attorneys will recoup $38,000 in fees from Carolina PT.

The case was investigated by the U.S. Attorney's Office for the District of South Carolina, the Defense Criminal Investigative Service and the U.S. Department of Health and Human Services Office of Inspector General. The civil settlement was reached by Assistant U.S. Attorney Beth Warren of the Columbia office.

The claims resolved by this settlement are allegations only, and there has been no determination of liability.