Press Release  Auditor Bump Says Lynn Physical Therapist Must Repay $359,266 to MassHealth for Improper Claims

Boston — In an audit released today, State Auditor Suzanne M. Bump finds Dr. Joseph O’Connor, a physical therapist and owner of Advance Physical Therapy & Sports Rehabilitation in Lynn, improperly billed MassHealth for $359,266 in claims. The audit shows he submitted claims to the program using his billing identification number, when those services were actually provided by physical therapy assistants. Bump’s audit notes that state regulations do not allow for payments for therapy services provided by physical therapy assistants, even while under the supervision of a licensed therapist.

“The MassHealth program only allows payment for physical therapy claims for services provided by licensed physical therapists. Billing for services provided by physical therapy assistants is a clear program violation,” Bump said of the audit. “Since this audit only reviewed a sample of all claims, further review by MassHealth may reveal additional improper billing.”

During the audit, which examined the period of January 1, 2015 through December 31, 2018, MassHealth paid Dr. O’Connor $568,988 to provide physical therapy services for 1,129 MassHealth members. A review of Dr. O’Connor’s billing records found 49 percent of sampled claims were improperly billed to MassHealth. In response to the audit, MassHealth indicated it plans to recoup improper payments and conduct its own internal audit.

Bump’s office initiated this audit after its Bureau of Special Investigations, which investigates fraud in public assistance programs, identified billing irregularities regarding Dr. O’Connor.

MassHealth is administered by the Executive Office of Health and Human Services, through the Division of Medical Assistance. The state’s Medicaid program annually provides access to healthcare for approximately 1.9 million eligible low- and moderate-income children, families, seniors, and people with disabilities. In FY18, MassHealth paid providers more than $15 billion, of which 50 percent was funded by the Commonwealth. Medicaid expenditures represent approximately 39 percent of the state’s total annual budget.

The audit of claims submitted to MassHealth by Dr. Joseph O'Connor is available here.

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