Fraudulent Billing

As a registered physical therapist, you are responsible for all billing under your name and registration number. We sometimes hear from registrants who discover that their name has been misused for billing purposes, for example by office staff at their clinic (intentionally or unintentionally) or perhaps the ongoing use of their registration number by a workplace after they have left the practice. You might discover this yourself when reviewing your own financial records, or you may be contacted by Medical Services Plan (MSP), Insurance Corporation of BC (ICBC), or a third-party insurance company when they conduct a random audit and notice inconsistencies or questionable practices.

What should you do?

First, know that you are not alone – the College receives reports from a number of physical therapists each year who have experienced the same thing. It can be quite distressing. The College regulates physical therapists (not clinics or workplaces), but we can help you understand your next steps.

If you would like to talk through the situation, contact our Practice Advisors at practicequestions@cptbc.org

Situation 1

  • The individual who used your name and registration number is a physical therapist
  • The clinic/organization that used your name and registration number is owned by a physical therapist

We can make further inquiries. If this is your situation, please file a formal complaint by completing an online complaint form.

Situation 2

  • The clinic/organization that used your name and registration number is owned by another regulated healthcare professional in BC

You should file a formal complaint with their College. A list of the health profession colleges with links to their respective websites can be found on BC Health Regulators website.

 

In either situation, or if the individual or clinic/workplace owner is not a regulated healthcare professional:

You should notify and report your discovery to the insurance provider involved:

You should reach out to your own malpractice insurer; they typically provide free legal advice to policy holders and may have helpful legal advice depending on the circumstances.

You should consider reporting the matter to the authorities (the RCMP or Police in your location) and/or the Canadian Life and Health Insurance Association benefits fraud reporting portal.

Let the College know:

If you haven’t filed a formal complaint with us (i.e., if the individual or clinic/workplace owner is not a registered PT), you are welcome to forward any information or documentation you have regarding your situation to us at complaints@cptbc.org. This is not required, but when we receive your information, we will open a file to record that another individual/organization has used your name and registration number for billing purposes without your consent. If you would like to do this, please provide the following information:

  • your name and contact information
  • the name and address of the clinic/workplace
  • the name of the clinic owner and/or manager (including contact information) if you have it
  • the dates that you worked there
  • the name and contact information of the insurer who contacted you (if they did)
  • any other information you believe would be helpful

To prevent this from happening (ever, or again), here are a few things to keep in mind:

  • Limit access to your registrant number and billing number to only those who would need to use it.
  • Periodically audit the claim forms that are submitted using your name and registration number and ensure you understand the billing codes used and amounts charged.
  • Exercise caution in providing an electronic signature by understanding how it will be used and who will have access to it.
  • Refuse to sign blank treatment plans/forms.
  • Update your CPTBC registrant profile within 5 business days of leaving a clinic/organization as required by the College Bylaws.
  • Exercise due diligence with potential new employers by:
    • asking questions about their business and billing practices
    • informing them that your name and registration number cannot be used for any services you do not provide
    • discussing your professional obligations to monitor any billings made under your name and registration number

Other CPTBC Resources:

Starting a physical therapy practice (your own, or joining another practice)

Leaving a physical therapy practice

Practice Standard 10: Fees and Billing, Part (e)

Code of Ethical Conduct: Responsibilities to the Public, Part 5

 

Published: November 29, 2022