Dear WSJ:
I loved your article Confidentiality Cloaks Medicare Abuse regarding physical therapy billings and your previous article Top Spine Surgeons Reap Royalties on the questionable payments by spinal implant companies . By the way, I spend a lot of time in Louisville, KY and now feel fortunate that apparently I am one of a handful of folks who don’t have an incision on their back. I do think your article on physical therapy could have gone deeper.
The issue behind the issue is conflict of interest via self referral to entities in which the doctor benefits financially. All of the examples as best that can be told are physician’s billing for “in house” physical therapy (or “office girls” per Rock Doc). The Russian PT who appears to be doing home care is an exception and it looks like out and out fraud. The Brooklyn PT scenario needs to be explored in greater detail as that billing could have possibly included a clinic with multiple PT’s. While physical therapy at 3.5 Billion is less than 1% of medicare expenditures, it is a hi source of abuse-namely by physician’s billing for services in which they financially benefit. I wish you would write a follow up article in which you seek answers to the following questions:
Why would doctors bill physical therapy? Just as you wouldn’t expect an imaging center to bill for kidney transplants, the fact that medicare allows for self-referral of professional services alone is a cause of suspicion for abuse.
Why doesn’t medicare differentiate by physical therapist in independent practice versus physician’s billing for physical therapy?
WSJ in the past has reported the abuse of self-referral in imaging. Isn’t there a pattern here?
The article really highlights what is already widely known in the industry. However, this is not well known amongst patients/consumers who are simply told to get physical therapy in a physician’s office or not given any choice at all. As crazy as it sounds, while conflict of interest is a well known issue subject to disclosure in most business situations, in most states disclosure of financial interest does not even have to occur.
Thanks again for highlighting the abuse.
larry@physicaltherapist.com
