Geico v. 20617
In Geico v 20617 filed in 2020, Geico claimed that a clinic was licensed with AHCA, but it had a medical director that was “appointed in name only.”
Also, Geico claimed that if the medical director performed systematic reviews of the files, he would have noticed that massage therapists were performing physical therapy and without proper supervision. Specifically, the massage therapists were billing for:
- 97530 (therapeutic activities);
- G0283 (unattended electric stimulation);
- 97035 (ultrasound);
- 97530 (therapeutic activity);
- 97112 (neuromuscular reeducation);
- 97140 (manual therapy);
- 97110 (therapeutic exercises);
- 97012 (mechanical traction therapy); and
- 97018 (paraffin bath therapy).
Geico also “did the math” and found that some days the Clinic performed more than 24 hours in one day of timed therapy codes.
Geico also complained the clinic was billing 95851 (range of motion testing) separately from 99203/99204 claiming that it should be included in the exam code. Geico pointed out that the clinic never provided a report with the details of the range of motion testing.
Geico claimed that if the medical director did his job as required by Florida Statute 400.9935 then he would have taken immediate corrective action and stopped it from happening.
DISCLAIMER
This is based on a real court case that was previously filed against a medical provider/doctor. The case number has been partially redacted and names have been changed to protect the Defendants’ names. This example is posted to help educate others on the laws and potential pitfalls. This posting is not intended to embarrass or defame anyone. I have limited the information and simplified some of the facts in the lawsuit to reflect key points and make a complicated case easier to understand. This “example” is directly from a complaint filed by an insurance company; therefore, I am using the facts THEY presented. There are always two sides to a story so please understand this is just one side of the story. This information was found through records available to the public.