Physical Therapy Expert Finds Care Center Breaches Medicare Boundaries

Court: United States District Court for the District of Idaho
Jurisdiction: Federal
Case Name: United States ex rel. Suter v. Nat’l Rehab Partners, Inc.
Citation: 2009 U.S. Dist. LEXIS 88630

Facts

This case involves claims of inappropriate physical therapy services by the Magic Valley Regional Medical Care’s Transitional Care Unit (TCU). The plaintiffs alleged that TCU had failed to maintain physical therapy facilities in accordance with Medicare criteria and that patients had not received appropriate treatment per diagnosis. The plaintiff retained a physical therapy expert witness to review patient treatment documents and give testimony on TCU’s accordance with Medicare guidelines.

The Physical Therapy Expert

The physical therapy expert witness was a practicing doctor of physical therapy at the Lattimore Physical Therapy and Sports Rehabilitation Network. Her responsibilities included maintaining specialized facilities providing exercise, manual therapy, education, massage, and mobilization services in order to individualize care for each patient. The physical therapy expert held both a bachelor’s and a doctorate in physical therapy from Nazareth College. She was also published in the American Physical Therapy Association Home Health Section Quarterly Report for her case report on grip strength and fall risk in a patient with post-polio syndrome.

The physical therapy expert witness was presented by the plaintiffs specifically to examine the physical therapy documents of clients receiving treatment at TCU, to determine whether the hospital provided Medicare-approved facilities, and opine on whether TCU patients obtained appropriate individualized treatment or group therapy.

Upon her review of the case materials, the physical therapy expert stated that the defendant’s methods breached Medicare boundaries on group therapy criteria. This was due to the timing and volume of patients in a session and the dearth of paperwork documenting patient progress or individual treatment. She also noted treatments consisted of similar exercises and were comparable between clients regardless of their situation, diagnosis, or progress.

The defendant moved to have the physical therapy expert’s testimony omitted, claiming it was not based on adequate evidence or information. The defendant further argued that the plaintiff chose the records for the expert’s evaluation and this could improperly serve the expert with a partial view of files that may sway her view. The defendant asserted this would render the testimony inadmissible per Rule 702.

Discussion

In response, the plaintiffs argued that the expert’s methodology was based on a thorough review of all relevant documentation, including the patients’ physical treatment records provided by the defendant. The physical therapy expert witness had then reviewed the nature and frequency of the exercises performed, the therapist’s notes and evaluations, and the duration of the therapy. The expert then created a diagram to look for a pattern of group therapy session data.

The court stated that the defendant had not provided adequate information as to how the expert’s conclusions were skewed or otherwise unreliable. The court noted that the expert had consulted all the physical therapy paperwork given to her by the defendant per the discovery request. The court also found that the defendants had not presented tangible proof that the specialist had relied on inadequate data and facts.

Held

The court found the physical therapy expert witness’s methodology to be reliable and, thus, her testimony was admitted.