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Massage Today
November, 2010, Vol. 10, Issue 11

Insurance Fraud and Massage Therapists

By Vivian Madison-Mahoney, LMT

This is to inform all therapists who work for physicians, MDs, chiropractors, massage therapists or other providers who bill insurance for their services to be aware of possible fraud; it is your license and your reputation on the line if others are using you to their advantage.

More and more, fraud and in some cases, organized crime, is taking place involving massage practitioners.

Abuse is most common among newly licensed or just out of school therapists where the therapist, though not involved in fraud and abuse themselves, is unaware of billing rules, legal and ethical documentation guidelines, correct coding and other insurance-related issues. Therefore, they are easy targets for those who hire them with intentions of making a lot of money by running insurance mills, or taking advantage of patients and their insurance.

Again, many therapists are not even aware that illegal or unethical activity is taking place nor of how serious the situation can become if the offices they work for come under question by authorities. This article is meant to help inform and protect you from activities that could eventually cause you to lose your license if not face possible prosecution, penalties and jail time.

What's happening?

Insurance Fraud - Copyright – Stock Photo / Register Mark You may be working for a "clinic" or other medical arrangement where you are asked to perform many procedures and modalities during a single patient visit, such as: hot/cold packs, manual therapy, massage therapy, neuromuscular re-education, ultrasound, electrical stimulation, therapeutic exercise, therapeutic activities, manual traction, mechanical traction, and other such procedures and modalities. Commonly, the office uses checklists and has the therapist check off the modalities and procedures performed. However, often times checkmarks are added after the therapist has submitted their paperwork, while the therapist is none the wiser.

It is not that some or all of those procedures and modalities are not in our scope of practice and training (depending on state licensure) but certainly, it is impossible to perform each of them within the normal treatment session of no more than one hour. Further, when there is a lack of thorough daily documentation (using just checkmarks is not thorough), it can lead to open-door fraudulent actions.

We are trained licensed practitioners and we should know not only our scope of practice but also what is within our legal, moral and ethical boundaries. Over-coding, over-billing and over-treating or documenting what is not provided are certainly not what we should be doing if we want to continue to build our professional image within the massage, medical and insurance communities.

I have received numerous calls over the past year or so from very concerned and frightened LMTs who have been caught-up in this sort of practice working for others. Sadly, there are still a whole lot of massage therapists who by choice, fear or intimidation are still working for this sort of practice. If you (or someone you know) is involved in such activities whereby you are told to perform many treatment modalities and procedures in one session, you might be involved in criminal activities.

The maximum in our industry standards is normally no more than four procedures and two modalities when noted on written prescription - not eight to 12 as some are performing. You might be involved in criminal activity if:

  • patients are being asked to return daily for weeks on end, or if you do not have a written prescription designating duration, frequency and procedures to perform;
  • you are asked to sign documentation or incomplete billing claims where you do not know exactly what you are signing; and/or
  • you are not performing complete 15-minute sessions per each procedure on the patient. For example, you spend a minute or two doing one thing and move to the next for five minutes, and so on.

As insurance consultant for the Florida State Massage Therapy Association (FSMTA), I first presented this information in FSMTA's Massage Message magazine. Since, I have been requested by insurance fraud divisions, the FBI, police investigators, and attorneys to provide information about our scope of practice, coding, industry standards for massage billing and to review suspected massage therapists' billing forms and practices.

I would highly advise that you pay special attention to the services you are asked to provide, and the paperwork you are asked to sign. As a legitimate independent contractor you should be able to request any file or patient record that you have created. By learning how to accept and bill insurance (when and where it is feasible), you can avoid falling victim to fraud.

Know too that all medical providers are not dishonest and as always, it is the one bad apple that spoils the bushel. So forewarned is to be forearmed.

Author's note: I am not a legal advisor, CPA or accountant. Please be sure to consult with proper authorities if you have any questions or concerns that pertain to a medical facility that you work for.

Click here for previous articles by Vivian Madison-Mahoney, LMT.


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