• Is It Fraud or Abuse?

    Concerned about a particular billing practice, business arrangement, or other relationship? Below is a list of potential resources that can help:

    Legal issues can arise in working for and/or running any business. For assistance with such legal matters, PTs and PTAs should seek advice of legal counsel. APTA.org provides advice for securing legal counsel and finding an attorney.

    Reporting Fraud and Abuse

    If you are engaged in or have witnessed a relationship or billing practice that you think is problematic, consider taking the following steps:

    • Contact the compliance officer if there is one in the facility.
    • Immediately stop submitting the problematic bills.
    • Seek knowledgeable legal counsel.
    • Determine whether there are any overpayments that need to be returned.
    • Disentangle yourself from the problematic relationship.
    • When appropriate, consider reporting information to OIG or CMS, particularly in cases in which the compliance officer has not responded appropriately.

    Contact OIG

    OIG has a hotline for reporting fraud anonymously:
    Phone: 800-HHS-TIPS (800/447-8477)
    E-mail: HHSTIPS@oig.hhs.gov
    TTY: 800/377-4950
    Mail: Office of Inspector General
    Department of Health and Human Services
    Attn: Hotline
    PO Box 23489
    Washington, DC 20026

    Contact Private Insurers

    A list of private health care fraud contacts is available via the National Health Care Anti-Fraud Association.

  • Last Updated: 12/5/2014
    Contact: advocacy@apta.org