Wow, I just found this one on Body Rehab Center. Report: #572925 By: Kathy P
Polly Badt, License Number: 15196, has been engaging in medical billing fraud by submitting and billing 5 units (75 minutes) of physical therapy, while only 45 minutes or less (2 to 3 units) was provided. Also in question are the codes used, over-billing, double billing, duplicate charges, and billing for appointments not made. Plus she lies (says she will only charge you for your portion if your insurance does not pay), and is misleading about her billing.
All of Pollys appointments were in 45 minute slots, so the actual physical therapy was less than that. I only received massage therapy and sometimes ice & ultra sound. Any units after the 2 to 3 units of physical therapy are fraudulent (2 units would be under 38 minutes of PT and 3 units would be 38 to 45 minutes (up to 52 minutes) of PT as I understand it).
The other billing fraud would be the dishonesty in the amount she charged for the 3 units of services she did render. She provided a sheet that said the insurance policy pays 75% and the patient pays 25%, approximately $30 per visit and later she changed the value to $33.75. This would mean 100% would be $120, or later $135, for the cost of a 45 minute visit (which still seems like over-billing per unit when I see physical therapist that are only charging $75 for 45 minutes even today). However, she charged $144 ($9 to $24 higher than she said), plus the additional $80 for services not provided, totalling $224 for less that 45 minutes of therapy. On top of that, she lied to my face and said that if my Blue Cross would not cover my visits, that she would only charge me my portion (the 25%), like she did for many of her patients, yet she charged $144+$80 for every single visit. So I fell for the lie that she would charge me ~$30 per visit, while instead she charged $224. If she had been honest and said that she would charge $144 plus another $80 for services not provided, I would have stopped going after my first couple of visits.
If she only worked 6 hours per day, she could see 8 patients in the 45 minutes time slots, where she overcharged at least $80 per visit for the services not provided (even more if you add in the over-billing of the real PT), so she made AT LEAST $640 (8x$80) in fraudulent charges per day, $3200 per week, and in about a year (50 weeks), she would have made AT LEAST $160,000 from medical billing fraud. I have had other physical therapist and chiropractors and none of them engaged in this blatant medial billing fraud. I figure with the number of visits that I had (from 2001-2005), that she overcharged me a minimum of $18,480 for services not provided, and overcharged me anywhere from about $2100 up to $16,000 for the services she did provide. Thats around $20,000 to $34,000 in medical billing fraud charged to me and my insurance. This is extremely damaging to me financially, especially since I have been chronically ill most of my life and I see a lot of medical specialist, and it is also damaging to have my insurance over-billed, which is deducted from my lifetime benefits.
Also, when I contacted Blue Cross, they said they would have covered some of the visits that they did not cover if Polly had submitted the claim in a timely fashion. I do not believe that any of the people working at her Body Rehab Center (which is not even a legal entity) were certified in medical coding. I know that Blue Cross told me that they would have covered everything with the correct coding, since I had a prescription for all my visits. So in fact Blue Cross would have covered far more of my visits, if not all of them, if Polly and her staff were properly trained and certified in medical coding (and competent enough to send it out on time).
She was also very unprofessional and cancelled my last few appointments without notifying me, causing me to drive about 20 minutes one way, only find out that my appointment was cancelled. I made another appointment, but when it came time to go, I called first so that I didnt have to waste 40 minutes of driving, and found that it was cancelled again. I made one more appointment, but when I called and it was cancelled again I never went back, despite the extreme pain from the degeneration of my spine, numerous collapsed disks and severe muscle problems that I had (and still have), since they are genetic and physiological problems, not sports injuries.
An often cited recent example of the huge potential liability exposure under the Federal Civil False Claims Act [31 U.S.C. 3729(a)] is United States V. Krizek, 859 F. Supp. 5 (D.C. 1994). In that case, the government filed suit against a psychiatrist and his wife for submitting and conspiring to submit false claims to Medicare and Medicaid. The government alleged that Dr. Krizek billed for 45-50 minute psychotherapy sessions when, based on the time spent, he should have billed for 20-30 minute sessions. Because this alleged billing practice took place over a six year period and involved 8,000 claims, the potential liability for Dr. Krizek under the Federal Civil False Claims Act was in excess of 80 million dollars. Polly did the same thing, plus potential over-billing, when she billed for 5 units (75 minutes), instead of 2 to 3 units (30 to 45 minutes) and has easily gone over a million dollars in bogus billing.
Ask your health care provider if you have been billed for 5 units (3+2), or 75 minutes worth of time, then you can report your case to: Physical Therapy Board of California (https://app.dca.ca.gov/ptbc/complaint.asp) Attorney General's Public Inquiry Unit (http://ag.ca.gov/consumers/general.php)
Enforcement of Medicaid and Medicare Fraud is a coordinated effort of three federal agencies: The Office of the Inspector General, the Department of Justice and the Federal Bureau of Investigation.
"Recent legislation has provided a new avenue for prosecution of Medicare and Medicaid fraud. In the last session, as a part of the new Kennedy-Kassebaum sponsored Health Insurance Portability Act, Congress established a number of new federal crimes concerning the Health Care industry. The first of these is Health Care Fraud, 42 U.S.C. 1347. Under this statute, anyone knowingly and willfully executing or attempting to execute a scheme to defraud any health care benefit program or to obtain by fraudulent pretenses, representations or promises any money or property owned by or under the control of, any health care benefit program faces a fine or imprisonment for not more than 10 years, or both."