Medicare Cracks Down on Unnecessary Payments – POPTS Caught Red-Handed…Again

April 24, 2012


In an effort to protect the Medicare Trust Fund and ensure proper payments, the Centers for Medicare & Medicaid Services (CMS) implemented the Comprehensive Error Rate Testing (CERT) program. CERT measures the accuracy of Medicare fee-for-service (FFS) payments. CERT contractors generate a number of measurements and statistics that reflect how effectively providers submit their claims and how Medicare contractors review and pay those claims.

First Coast Service Options Inc. (FCSO) analysis of CERT errors identified a trend of increased claim payment errors in the November 2011 CERT report when therapy services are billed by a physician in the state of Florida. Services billed by physician specialties represented 70 percent of the dollars incorrectly paid for therapy services with a 19.05 percent claim payment error rate (based on dollars). Additionally, past medical review experience has identified high claim error rates when therapy services are billed by physicians.

“The most common reasons for an error to be assigned are insufficient documentation, including failure to meet Medicare’s documentation requirements specific to therapy services and failure to meet medical necessity.”

Data analysis indicates that therapy services billed by general practice specialty represent over 12 percent of all of the therapy services billed in Florida. Therefore, based on high error rates validated through CERT findings and FCSO’s data analysis, a prepayment medical review edit will be implemented on March 19, 2012. This prepayment edit will require submission of medical records to support physical therapy services billed by general practitioners.

Read the whole report by clicking here.


Physical Owned Physical Therapy Services are an avoidable REFERRAL FOR PROFIT conflict of interest.

The problems are clear to everyone now:

1.  It’s clear now what they are trying to maintain their kickbacks.

2. CA can’t afford this.

3. The cat is out of the bag – physical therapy care delivered at a POPTS is substandard care.

4. The public knows now that POPTS kill more PT jobs than create them.

5. POPTS are a monopoly – pure and simple.

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