In Denver, Acting United States Attorney Bill Leone announced that the United States has agreed to settle several claims that Sander J. H. Orent, M.D., Medically Based Fitness, and Arbor Medical Services improperly billed the Medicare program. Under the terms of the agreement, Dr. Orent and his companies have agreed to pay a total $150,000.00 to the Medicare program.
Between June 1996 through August 2004, Medically Based Fitness and Arbor Medical Services submitted thousands of claims to Medicare. The majority of these claims were for legitimate covered services. However, a review of patient files also revealed a substantial number of claims that were for prolonged exercise therapies that do not meet the requirements for Medicare coverage.
Because of the large volume of inappropriate claims, this case was initially opened as False Claims Act investigation. Dr. Orent cooperated with the investigation, and, partly as a result of information provided voluntarily by Dr. Orent, it was ultimately determined that the improper billings were not submitted intentionally or fraudulently by Dr. Orent, Medically Based Fitness or Arbor Medical Services, but were the result of a negligent misunderstanding of the Medicare regulations.
Medically Based Fitness’ and Arbor’s exercise program was new and was intended to benefit older, sick or injured individuals who otherwise would not be able to obtain the benefits of exercise therapy. However, Medically Based Fitness and Arbor submitted claims to Medicare for non-covered services. Medicare paid the claims because they had been submitted using standard physical therapy service codes which did not adequately describe the actual services.
Specifically, maintenance therapy and exercise conditioning are not covered benefits of the Medicare program. These types of therapy include general exercise to promote overall fitness and flexibility in an otherwise healthy individual, repetitive exercise to maintain gait or maintain strength and endurance, assisted walking such as that provided in support for feeble or unstable patients, and maintenance therapies after the patient has achieved therapeutic goals or for patients who show no further meaningful progress.
Leone stated, “It is important that providers remember that not all services which may benefit a patient are covered by Medicare. This is particularly true of general exercise programs.” Leone continued, “In this case Dr. Orent cooperated fully with the investigation and, although he and his companies incorrectly billed the Medicare program for services which are not covered, we were able to determine that this was not the proper subject of a False Claims Act suit. As a result, Dr. Orent and the related entitles are not being required to pay the treble damages and penalties which would have been authorized under the False Claims Act.”
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