The Situation

A newly registered PT Resident named Arianna began working at a private clinic—she was excited to have her first job as a physiotherapist. The clinic owner had two facilities and was a regulated health professional who was not a physiotherapist. 

After working at the clinic for just over a month, Arianna asked the receptionist for a print-out of her billings. The receptionist said that she didn’t provide that kind of information to staff. Arianna said, “It’s my right to see any invoice that uses my name and registration number and I want to see them!” The receptionist refused, so Arianna went straight to the owner and demanded a copy. He reluctantly gave her a copy of her billing records for the past month. 

Arianna was shocked to see that the invoices for both locations were incorrect—up to 90 per cent of the information was wrong. Patients were being billed for services that she had not provided.

What the PT Did

She immediately contacted the other PT Resident, Marcel, who worked at the same clinic and urged him to review his own billings, letting him know that she had found serious discrepancies between what she saw on the invoices and the services she had actually provided to her patients. Marcel found serious errors in his billing records as well. Both PTs were deeply uncomfortable. 

Arianna and Marcel agreed to stay in touch and share any information they found. As they were PT Residents, both called their PT Monitors to let them know what was going on and talk through the situation. Arianna reached out to the College’s Practice Advisor, Shelley Martin, to make the College aware and to find out what she could do in this kind of situation.

Shelley told Arianna that she had a number of options, she could: 

• Ask the clinic owner (in writing) to stop.
• Get in touch with Insurance Bureau of Canada and the Canadian Health Care Anti-fraud Association to report the situation.
• File a billing-related complaint about the clinic owner with his College as he was a regulated health professional.
• Speak with the College’s Professional Conduct team who could make a note of what was going on in Arianna’s College record so that it was documented (the Practice Advisor is not able to do this, just the Professional Conduct team).
• Contact local police or provincial Crime Stoppers to report the clinic owner.

After talking to Shelley and the Professional Conduct staff person, Arianna decided to confront the owner. She told him that she needed to meet with him and discuss her concerns about billing. They met before her shift the following day. The owner was uneasy and told her not to worry about it.

Arianna pushed back and the owner then said that the billing discrepancies were his way of helping patients who could not afford to access physiotherapy care, and he did that by manipulating invoices. 

Arianna explained to the owner that she didn’t want to hear his excuses. She was accountable for all billing that included her registration number and this was not an acceptable situation—it was fraudulent. She told the owner to call the insurance company immediately, cancel the improperly billed invoices, and then correct the invoice or she would call the insurers herself and report the clinic. She also demanded copies of all of the false invoices and the new invoices for her records.

Before quitting the clinic, Arianna and Marcel got in touch with the College again to see if there was anything else they should do before ending their relationship with the owner.

The Practice Advisor suggested having a look at the Leaving a Practice resource, to make certain they had done things like informing the employer in writing that their names and registration numbers could not be used after they left, making sure patient records were current so another PT could continue care, updating their employment information on the Public Register so it was clear they no longer worked at the clinic any more. 

Reference

From page 2 of Standard: Fees & Billing

Physiotherapists are expected to:

Audit invoices and billing practices at periodic intervals to ensure:

• the accuracy of invoices
• an understanding of the fees that are being charged for their services
• an understanding of how their registration or billing number
• is being used; and
• that when abnormalities are discovered, reasonable steps are taken
• to remedy the situation in appropriate circumstances.