PhysioHealth Inc. and its wholly owned company Dynamic Therapy Services, LLC agreed to pay $2 million to resolve allegations that it billed TRICARE for unallowable physical therapy services provided by non-authorized providers, including physical therapy assistants at clinics in Delaware, Pennsylvania, and Maryland.
Dynamic was sold to Pivot Physical Therapy in 2017.
The government launched an investigation after Dynamic voluntarily disclosed to the United States that between January 12, 2011, and January 23, 2017, Dynamic Therapy had provided professional services to TRICARE beneficiaries using physical therapy assistants, and then billed the services under the supervising physical therapist’s provider number. TRICARE provides health coverage to U.S. Defense Department employees.
At the time the services were rendered, TRICARE did not cover physical therapy services rendered by physical therapy assistants, since they were not considered authorized providers under TRICARE rules then in effect.
“Physical therapy providers have a responsibility to ensure that they are complying with billing regulations,” said U.S. Attorney William McSwain. “Dynamic Therapy and PhysioHealth discovered non-compliance problems internally. To their credit, they took corrective action to ensure that TRICARE beneficiaries are provided with services from authorized providers, and they came forward to voluntarily disclose to the Government what had occurred. Their proactive approach in this case sets a good example for other providers who might find themselves facing similar issues.”
“Ensuring the integrity of TRICARE, the Defense Department’s health care program, is a top priority for the Defense Criminal Investigative Service (DCIS),” stated Special Agent-in-Charge Leigh-Alistair Barzey, DCIS Northeast Field Office. “DCIS will continue to work with the United States Attorney’s Office and other law enforcement partners to protect TRICARE and the uniformed service members, retirees, and their families who rely upon it.”
Assistant U.S. Attorney Judith Amorosa and Auditor Dawn Wiggins handled the case for the U.S. Attorney’s Office. The matter was investigated by the Defense Criminal Investigative Services. The voluntary disclosure was made to the U.S. Department of Health and Human Services which assisted in the resolution of this matter.
