Case of the Month

Read real cases and their outcomes

Suspicious Spa Services

Feb 05, 2020

The Case

The College received a complaint from an insurance provider following their investigation of a physiotherapist. As part of the investigation, the insurance company sent an investigator to the wellness clinic that the PT was affiliated with. The investigator asked the staff if her spa services could be billed as physiotherapy so that she could be reimbursed by her insurance company. The clinic staff said yes and charged her $490 for a spa package.

Approximately two weeks later, the investigator attended the clinic for her spa appointment. Following the treatment, the staff took the investigator to another clinic next door for a physiotherapy assessment. The investigator was told that she needed to see a physiotherapist in order to receive money from the insurance company. The physiotherapist conducted a very brief assessment and told the investigator that she didn’t have any health problems.

The investigator never saw the PT for any follow up physiotherapy appointments; however, she was provided with a receipt for physiotherapy services using the PT’s name and registration number in the amount of $490.

The invoice indicated that six physiotherapy sessions were provided by the PT in the course of a month.

Shortly after, the insurance provider requested the patient records, but since these appointments never happened, there were no legitimate records. The physiotherapist provided the insurance company with fabricated patient records detailing one assessment and five treatment sessions.

Following the complaint from the insurance provider, the College reviewed additional patient charts from the PT. The College found that the charts did not support the invoices for services provided, assessments lacked adequate subjective or objective data, treatment plans were missing, and invoices with the physiotherapist’s name and registration number did not align with treatment dates.

The Standards

As outlined in the Fees, Billing and Accounts Standard, physiotherapists are accountable for any fee, billing or account that uses their name and registration number. PTs must ensure that any fee, billing or account is an accurate reflection of the services provided and must never charge fees or create billings that are inaccurate or misleading.

The Record Keeping Standard states that physiotherapists must maintain patient records that are well organized, understandable and accurate. Clinical records must contain objective data, evidence, and outcome measures whenever possible and appropriate. Financial records must contain the name of the patient, the name of the PT, date of the service, description of the care provided, the fee charged for the service and any payment received.

The Outcome

The physiotherapist had their license suspended for five months pending the successful completion of the ProBE Ethics Course and a full review of College standards and resources. If the PT does not successfully complete these two items, their suspension will be bumped up to 10 months. Upon their return to practice, they must complete a practice assessment followed by a two-year practice enhancement program. All costs associated with the remediation program will be paid for by the PT.

The physiotherapist also appeared before the Discipline Committee for a reprimand and is required to pay an additional $8,000 to the College. The outcome of this decision will stay on the Public Register permanently.

The primary goal of the College is to protect the public interest, and the public interest rests on the integrity of the profession. Fraudulent business practices reflect poorly on the profession and insurance companies are taking notice.
Sign up for the College’s webinar on February 20 called Business Practices: The Good, the Bad and the Ugly featuring College and insurance anti-fraud representatives. We’ll answer all your questions and help you ensure that you’re following good business practices and staying off the radar of investigators.
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Fees, Billing and Accounts Standard

Record Keeping Standard

Inappropriate Business Practices

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