Recently, Liberty Mutual Insurance brought a $17 million insurance and common law fraud lawsuit against Marque Medicos, a Chicago-based medical practice known for treating neck and back injuries of worker’s compensation claimants, alleging fraudulent billing practices.
In its August 17, 2016 complaint against Marque Medicos, Liberty Mutual Insurance alleged that Marque Medicos billed for therapy that they did not perform and billed at inflated rates. Liberty Mutual alleged that its investigation showed that Marque Medicos had billed at higher rates for such procedures as “attended electrical stimulation,” when “unattended electrical stimulation” was actually performed, and billed for “multiple units per visit of direct one-on-one” physical therapy, when they actually performed “single-unit-per-visit group therapy.” The lawsuit alleged the practice also billed for “hands-on therapy” that was never actually performed.
Liberty Mutual was joined by 17 other insurance companies. The insurance companies seek approximately $17 million for reimbursement of payments already made and for payments “wrongfully attempted to be obtained through the use of fraud.”
Obviously, any workers’ compensation claims involving treatment from this facility (or any, really) should be carefully scrutinized. Employers or their agents should carefully review the type, frequency, reasonableness, and necessity of treatment, utilizing a medical expert if necessary. Employers or their agents should also carefully review each medical bill, analyzing whether it matches the type of treatment being rendered and whether the bill appears to have already been paid.
We are hopeful for a positive outcome in this lawsuit for Liberty Mutual and the 17 other insurance companies that have joined in the lawsuit. If Liberty Mutual is successful, it can be expected that similar lawsuits will be filed against similar medical facilities. Either way, the suit will hopefully serve as a warning for medical facilities engaging in similar practices and will quell the amount of fraudulent billing that appears to be all too common in the area of workers’ compensation.