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Healthcare Provider Agrees to Pay $1.5 Million to Settle Alleged False Claims Act Violations Involving Unauthorized Physical Therapy Services

Monies taken from vital programs such as TRICARE and Medicare are bound to raise the ire of the FBI as was demonstrated last month when it investigated a leading healthcare provider for such actions. A spokesperson for the Justice Department announced back in January that Scripps Health (Scripps), a health care system based in San Diego, agreed to pay $1.5 million to resolve charges that it violated the False Claims Act by charging government health care programs for physical therapy services that were rendered by therapists who did not have billing privileges to charge for these services. “Federal health care programs require that services are rendered by authorized providers or under the appropriate supervision of an enrolled physician,” said Acting Assistant Attorney General for the Justice Department’s Civil Division Chad A. Readler. “These requirements help protect patients from unscrupulous or unqualified medical professionals. The Department of Justice will continue to ensure that those who knowingly violate these requirements face appropriate consequences.” “Holding providers accountable protects patients and tax-payer funded health care programs,” said Eric S. Birnbaum, FBI Special Agent in Charge of the San Diego Field Office.

Specifically, the government alleged that Scripps billed Medicare and TRICARE for physical therapy services which were then provided by physicians who did not have billing privileges. The government also alleges that this was done without the appropriate supervision by a physician. “This settlement illustrates the United States Attorney’s Office’s continued commitment to protecting the integrity of the Medicare and TRICARE programs,” said U.S. Attorney Adam L. Braverman. “Unlawfully obtained payment from taxpayer-funded programs harms the entire health care system. We will hold accountable all providers who defraud these programs.”


The settlement came about as the result of a lawsuit that was filed by Suzanne Forrest, a former Scripps employee, under the qui tam provisions of the False Claims Act. These provisions permit private individuals to sue for false claims on behalf of the government. The qui tam provisions also allow private individuals who do file suit against alleged violators of the False Claims Act to share in any recovery. Claimants can do so with or without the aid of whistleblower lawyers or by using a qui tam law firm. As part of this settlement, Ms. Forrest will receive $225,000. The civil lawsuit was filed in the Southern District of California and is captioned United States ex rel. Forrest v. Scripps Health, Case No. 16-CV-0634.

Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).