Posted and filed under Compliance, Fraud, FWA, Healthcare.

It’s more than money when your license is on the line. 

This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud experts.

This article continues a multi-part series that will be covering the top ten violations of law against physical therapists that are enforced by state licensure boards against these health care practitioners. 

As I wrote in my last published column, we will cover three violations at a time in three subsequent articles with a bonus tenth violation making ten in total to review.  Here is additional introduction to the issues.

Licensed physical therapists and certified physical therapist assistants have a property right in their licenses or certifications issued by the state to practice their chosen profession.  With that permission from the government, they therefore have a monopoly on practicing “physical therapy” as defined by state law, which varies from state to state.  In addition, and yet with some exceptions unique to some states, they also have a monopoly on the term “physical therapy.”  They have “title act” protections in so far as only a physical therapist or physical therapist assistant may call what they do “physical therapy” or bill for those services described as such.

Many young people aspiring to be a health care professional, here specifically a physical therapist, can explain in detail how you get to become a physical therapist – lots of schooling and examinations.  Few stop to ponder how you get not to be a physical therapist.  What fraud can you commit that will jeopardize your license to practice such that your license is suspended or revoked – not as punishment to the physical therapist, but to protect the public from the waste, fraud, and abuse committed by the guilty physical therapist.

From an enforcement perspective, violating applicable regulatory standards can have direct and indirect financial impacts for fraud, including possible criminal, definitely civil, and perhaps even malpractice consequences from the patient.

How is this more than mere ethics?  Don’t ethics codes prevent such fraud and misconduct?  True ethics codes are non-binding, whereas state law governs a physical therapist’s committing waste, fraud, or abuse.  The American Physical Therapy Association has a Code of Ethics that purports to set the standards stating:

The Code of Ethics for the Physical Therapist delineates the ethical obligations of all physical therapists as determined by the House of Delegates of the American Physical Therapy Association.” 

How wrong that is!

State law governs the obligations of physical therapists licensed in that state, and the APTA Code of Ethics is not typically incorporated or referenced in state laws anywhere.  It is merely ethical guidance and only to those health care professionals who choose to join the APTA as a member.

This brings us to the most important regulatory standard to prevent fraudulent conduct by imposing a minimal standard of care.  You can’t bill a patient for unproven treatment or for proven treatment that you have not competently performed.  Yet physical therapists are pretty good at “staying in their lane.” 

The profession of physical therapy tries to maintain the highest standards of practice, and we make sure our continuing education and on-going training is in line with our own state’s practice act.  We are usually very good about practicing within the scope and not overstepping our boundaries.  We all know our boundaries about what is legal or not and what you can or cannot do in a given state.  The majority of the profession does that.

Emily Suttor, DPT, PT, a physical therapist in Frankfort, Kentucky

Physical therapists and insurance companies need to know how substandard care or how practice outside the scope can constitute fraud and endanger one’s right to practice.  We will look at these additional violations of law against physical therapists.  Stay tuned to these future articles in this column.

About the Author

Mark R. Brengelman, JD, MA, practices health care law in Frankfort, Kentucky, where he is the immediate past Chair of the Health Law Section of the Kentucky Bar Association.  For fifteen years, he was the Assistant Attorney General assigned as General Counsel and Prosecuting Attorney to the Kentucky Board of Physical Therapy.  His e-mail is Mark@MarkRBrengelmanPLLC.attorney.