Scripps Health will pay $1.5 million to settle allegations related to improper billing for physical therapy services, according to the Justice Department.
The department alleged that Scripps therapists did not have authority to bill Medicare and Tricare for services but did so anyway, and that they acted without appropriate physician supervision.
Medicare and Tricare limit billing privileges to enrolled providers. Services from unenrolled providers can be billed as “incident to” the services of an enrolled physician, but only under direct supervision.
“These requirements help protect patients from unscrupulous or unqualified medical professionals,” Chad Readler, acting assistant attorney general for the Justice Department’s Civil Division, said in a news release.
The settlement resolves allegations filed in a lawsuit by Suzanne Forrest, a former Scripps employee, under provisions of the False Claims Act, which allow individuals to sue for false claims on behalf of the government and to share in recovery. She will receive $225,000 as part of the settlement.
Scripps Health did not return a request to comment.