Board successfully holds physiotherapist accused of health insurance and Medicare claim fraud to account

22 Aug 2017

The Physiotherapy Board of Australia (the Board) and the Australian Health Practitioner Regulation Agency (AHPRA) have successfully prosecuted a South Australia physiotherapist found by a tribunal to be fraudulent and deceptive.

The South Australian Health Practitioners Tribunal (the tribunal) found the behaviour of Ms Vanessa Soo was a ‘systematic, detailed and elaborate deception perpetrated on the health insurance funds on a grand scale’ and an ‘expensive deception for the private health insurers and a significant breach of trust towards them’.

After investigating a notification made by a former employee, the Board brought disciplinary proceedings against Ms Soo alleging she had:

• backdated patient visits to facilitate claims on Medicare under the Enhanced Primary Care Program 
• split claims to private health insurers for a single long consultation into two short consultations on separate dates to maximise the level of rebate, and 
• kept inadequate clinical records.

In addition the Board alleged that Ms Soo misled the Department of Human Services, health insurers and AHPRA during its investigation into the alleged claim splitting and backdating.

The tribunal found that between 2007 and October 2011 she had engaged in professional misconduct and unprofessional conduct and that all allegations were proven. The tribunal reprimanded Ms Soo, suspended her registration for 18 months and placed conditions to complete education and training before the suspension ceases. Ms Soo was also required to pay the Board’s costs.

The tribunal also ordered that when Ms Soo’s suspension ceases she will be subject to conditions including two years of supervision and random audits.

In disciplining Ms Soo, the tribunal pointed to Ms Soo’s constant, persistent and false denials of the allegations made against her. It found that though she admitted to some of the allegations she did not have any genuine remorse and lacked insight as to the seriousness of the overall conduct. The tribunal concluded that Ms Soo is ‘not a practitioner to be trusted’.

Physiotherapy Board of Australia Chair, Charles Flynn, said the decision was a reminder to practitioners that there is no place for fraud and deception in the practice of physiotherapy.

‘As the regulator of the physiotherapist, our purpose is to help keep patients safe. Registered physiotherapists must meet national standards and are held to account’, said Dr Flynn. The decision emphasises the need ‘to assure the public that proper standards are being maintained in the profession and thereby to uphold public trust and confidence in it.’

‘The Code of conduct is there to remind practitioners of their obligations, while holding them to account if required to protect patients. Practitioners must always ensure they are maintaining adequate records and cooperating with any legitimate inquiry. Inappropriate record keeping and lack of cooperation by the practitioner in this case was found to be deliberate attempts to mislead. This is unacceptable.

‘Practitioners have a duty to make the care of patients or clients their first concern and to practise safely and effectively. Maintaining a high level of professional competence and conduct is essential for good care.’

The tribunal’s decision is available on the Austlii website.

Patients and members of the public with concerns about the care they receive from their registered health practitioner can call AHPRA on 1300 419 495.