Manhattan U.S. Attorney Settles Civil Fraud Lawsuit Against Physical Therapy Center And Its CEO For Improper Medicare Billing

Geoffrey S. Berman, the United States Attorney for the Southern District of New York, and Scott J. Lampert, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s New York Region (“HHS-OIG”), announced today that the United States filed and settled a civil fraud lawsuit against FUSION PHYSICAL THERAPY AND SPORTS WELLNESS, P.C. (“FUSION”), and its founder and CEO, CAROLYN SUE MAZUR (“MAZUR”), alleging that FUSION and MAZUR violated the False Claims Act by fraudulently billing Medicare for physical therapy services that were not reimbursable under that program.  Specifically, FUSION and MAZUR falsely claimed to Medicare that various services had been provided or supervised by a physical therapist who was credentialed in the Medicare program and therefore authorized to bill Medicare for reimbursement when, in fact, the services were provided or supervised by other non-credentialed personnel.  Under the settlement, approved yesterday by U.S. District Judge Ronnie Abrams, FUSION and MAZUR admitted to the wrongful conduct and agreed to pay $37,500.

Manhattan U.S. Attorney Geoffrey S. Berman said:  “Medicare requires all health care providers accurately to report information relating to claimed services.  This requirement is critical to ensure quality of care and patient safety.  Fusion Physical Therapy side-stepped this rule by lying to Medicare about who actually provided the services, and is now being held accountable.”   

HHS-OIG Special Agent in Charge Scott J. Lampert said:  “Health care professionals are expected to bill the taxpayer-funded Medicare program correctly.  Along with our law enforcement partners, HHS-OIG will continue to ensure individuals and entities billing federal health care programs do so in an honest manner.”

According to the Government’s Complaint-in-Intervention, MAZUR and FUSION knew that Medicare rules prohibited them from billing Medicare for services performed or supervised by non-credentialed physical therapists.  MAZUR and FUSION also knew that Medicare rules prohibited them from misrepresenting to Medicare the individual physical therapist who had provided the services underlying a claim for reimbursement.  In spite of this knowledge, FUSION and MAZUR billed Medicare for services that had been rendered by non-credentialed providers and made false representations regarding the true identity of the providers who rendered the services.

As part of the settlement, MAZUR and FUSION agreed to pay $37,500 and admitted that:

• Defendants understood that they were prohibited by Medicare rules from submitting claims for reimbursement for certain professional services provided by a healthcare provider other than the individual associated with the National Provider Identifier (“NPI”) listed on each claim.
   
• Defendants also understood that, in order to receive reimbursement from Medicare for physical therapy services, the physical therapist listed on each relevant claim must be enrolled as a provider in the Medicare program at the time the services are rendered.
   
• Defendants submitted to Medicare false claims for services that had been performed by physical therapists other than the physical therapist whose NPI was listed on the claim.
   
• In some cases, the physical therapist who actually provided the claimed services was not enrolled as a Medicare provider at the time the claimed services were rendered.
   

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Mr. Berman praised the outstanding investigative work of HHS-OIG.  This case is being handled by the Office’s Civil Frauds Unit.  Assistant U.S. Attorneys Charles S. Jacob and Jessica Jean Hu are in charge of the case.