Team Rehabilitation Services Agreed to Pay $12.2 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services that Were Not Reimbursable and Services that Did Not Meet the Requirements of Time-Based Codes

After it self-disclosed conduct to OIG, Team Rehabilitation Services (TRS), Michigan, agreed to pay $12,256,518.14 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that TRS improperly billed certain Medicare Part C plans for time-based CPT codes for Physical Therapy (PT) therapy services by improper calculation of 15-minute units when a therapist had not treated a patient for at least 8 minutes. OIG also alleged that TRS improperly billed Federal health care programs for routinely performing PT reevaluations under CPT code 97164, when routine, continuous assessment of a patient’s expected progress in accordance with a therapy plan of care is not considered to be a medically necessary service and is not separately reimbursable as a reevaluation.

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