I have been thinking about fraudulent billing practices a lot lately. Not such a cheerful way to begin the New Year, I know.
This won’t come as much of a surprise to you if you have been following the College’s activities over the past 18 months: one of our strategic goals is to improve the protection of the integrity of the title physiotherapist and the College registration number. What Council intended when they developed this goal was to ensure that all physiotherapists uphold the good reputation of physiotherapy in their billing practices.
Why did Council feel such a goal was necessary?
We see cases where new physiotherapists are pressured into inappropriate billing or where unwary PTs fail to audit the billing practices of their employers. We also know that some physiotherapists are billing for services they did not provide, or billing for things that could not reasonably be called physiotherapy.
Our neighbours to the south also see such cases and they’re taking a hard stand with heavy penalties for health care fraud. Just recently a physical therapist in Michigan was sentenced to 10 years in prison for filling in blank insurance claim forms and a New Jersey coach is now facing 10 years in prison for falsely billing insurers for physical therapy.
Despite evidence that some PTs are not behaving appropriately, we believe that clinic owners who are not physiotherapists orchestrate the vast majority of inappropriate or fraudulent billing that takes place under your names and registration numbers. Since it is your responsibility to audit all billing and prevent misuse, it is you who are ultimately accountable for the wrong-doing of others. And, as I said, it makes all physiotherapists look bad.
Perhaps you have had some personal experience that connects you to this problem. Many of you participated in the professional credential tracker (PCT) pilot that we did last year. The PCT is an electronic tool developed by the Insurance Bureau of Canada (IBC) to support regulatory colleges and help their registrants stay informed about how their professional credentials are being used in Health Claims for Auto Insurance.
Some of you no doubt learned that facilities you had never been affiliated with used your registration number, or that your registration number had been used to process payments by a clinic long after you had stopped working there.
So what’s a College to do?
Council has proposed that we begin to explore regulation of the clinics themselves. Just like pharmacies are regulated by the College of Pharmacists, our College could regulate clinics that offered physiotherapy. If this were the law, physios would work for physios: that would allow you to feel comfortable in the knowledge that your employer would be held to the same high standards as you are yourself.
Changing the law would be a slow process and not entirely within our control. At this stage, we are just starting the conversation. Please, let’s start here.
What do you think?
I have been thinking about fraudulent billing practices a lot lately. Not such a cheerful way to begin the New Year, I know. This won’t come as much of a surprise to you if you have been following the College’s activities over the past 18 months: one of our strategic goals is to improve the […]