News & Commentary

Whistleblower Claims Result in Prison Sentence and Restitution for NJ Physicians

In a recent case, U.S. District Judge Robert B. Kugler sentenced a New Jersey osteopathic doctor and his chiropractor son to $890,000 in restitution and prison time for Medicare fraud related to having unqualified individuals provide physical therapy at their medical practice. Both doctors pled guilty to conspiracy to commit health care fraud charges. They also agreed to pay more than $1.78 million to the federal government for related civil claims.  A former billing manager who initiated the allegations will reportedly receive approximately $338,200 and her legal fees.

Medicare regulations permit billing for physical therapy if the doctor administered the therapy or supervised therapy provided by a licensed physical therapist or a graduate of a physical therapist education program.  Supervision requires the doctor to be in the office and immediately available to assist.  The government argued that the defendants falsely billed for services provided because they did not directly provide the therapy, often were not present, PT was provided by unlicensed and untrained individuals, and some patients were billed for individual therapy but received services in a group setting.

The cases are USA v. Robert Claude McGrath and USA v. Robert Christopher McGrath, in the U.S. District Court for the District of New Jersey.