When headlines announce six-figure or seven-figure False Claims Act (FCA) settlements, it’s easy to assume the underlying misconduct involved massive volumes of improper billing. But in the latest episode of Deeper Than the Headlines, CJ Wolf breaks down a Florida physical therapy case that proves just how misleading that assumption can be.
In this case, a physical therapy practice agreed to pay approximately $754,000 to resolve FCA allegations tied to roughly 500 claims—a relatively small number by most standards. The government alleged that the practice billed Medicare for physical therapy services under the name of a licensed physical therapist who was frequently not present when the services were performed. In some instances, the therapist was reportedly out of the country.
What drove the settlement amount so high wasn’t the value of the claims themselves. In fact, the restitution portion totaled less than $20,000. The real financial impact came from treble damages and civil penalties, which the FCA allows when claims are knowingly submitted inaccurately.
Beyond the monetary settlement, the resolution included several compliance obligations that should feel very familiar to healthcare organizations:
- Appointment of an external compliance officer for three years
- Development and implementation of billing and coding policies and procedures
- Ongoing employee training related to billing, coding, and documentation
- Potential additional penalties if compliance requirements are not met
This case also followed a common enforcement pattern: it began with a whistleblower complaint filed by a former employee under the FCA’s qui tam provisions.
The takeaway is clear. FCA risk is not only about volume—it’s about process, supervision, documentation, and accountability. Even a small number of improperly supported claims can quickly escalate into significant financial exposure when enforcement mechanisms kick in.
CJ Wolf
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