CYBER PHYSICAL THERAPY BEING TRIED BY VETERANS

FROM:  NATIONAL SCIENCE FOUNDATION
Veterans will be first to try cyber physical therapy
High-speed research networks help scientists develop and deploy future health technologies

The Internet has been transformational, changing how we communicate with friends and family, how we shop, and more recently, how we heal. Physical therapy is the latest treatment to be offered as telemedicine, with an experimental system now connecting specialists to patients to provide help they otherwise couldn't get, aiding recovery from serious ailments, from broken limbs to stroke.

In an effort to connect physical therapy with wounded veterans far from treatment facilities, researchers from the University of Texas (UT) at Dallas have developed a rehabilitation system that uses real-time video, 3-D computer-generated worlds and force-feedback "haptic" devices to re-create a physical therapy session between a patient and a therapist, all at long distance over high-speed networks.

The team demonstrated the system at the Beyond Today's Internet Summit in March 2015. Organized by US Ignite and the Global Environment for Networking Innovations (GENI), two groups dedicated to advancing the frontiers of the Internet, the event showed what new capabilities are possible with ultra-high-speed, "smart", programmable networks.

Powerful Internet brings powerful applications

Though the majority of U.S. citizens still have Internet connection speeds in the tens of megabits per second, through the GENI and US Ignite programs, supported by the U.S. National Science Foundation, researchers, experts and some communities are able to access gigabit networks with speeds 40-100 times faster than standard networks.

For 3-D tele-rehabilitation to be lifelike and effective requires the system to have virtually no lag-time--or latency, in networking lingo--between action and reaction.

"To transfer all of this data requires a bandwidth greater than 100 megabits per second, which we currently can't do over the Internet," said Karthik Venkataraman, a Ph.D. student working on the computer-enabled health technologies in computer scientist Balakrishnan Prabhakaran's Multimedia Systems Lab at UT Dallas."GENI and US Ignite provide the bandwidth and low latency that is required by these kinds of applications."

Reach out and touch someone

Every year, physical therapists help millions of people recover from the debilitating impacts of strokes, injuries and a range of other ailments--but not everyone has access to a treatment facility or a physical therapy professional.

"We're trying to virtualize a physical therapy session in which a patient and a therapist cannot be present at the same location," explained Venkataraman.

To bring the tele-rehabilitation to life, the system uses Microsoft Kinect to create 3-D, real-time models of the patient and the doctor. The models then join a shared virtual environment, a computer-generated space customized by the participants.

To simulate the touch aspect of the physical therapy session, the patient responds to a touch-sensitive "haptic" arm controlled by the therapist via a paired haptic device.

At the summit, the team demonstrated a physical therapy session in which two individuals practice sawing a log, a task that mimics the movements used by recovering stroke patients. The participants feel both the resistance of the log and the guiding movements of their partner, just as would occur at an in-person therapy session.

The researchers say this is just one example of what can be achieved with next-generation networks that support high-bandwidth and low-latency communication. The team is also working on extending the tele-rehabilitation system so one therapist or physician can work with multiple patients at the same time.

"This scaled-up version will ensure privacy in the sense that the patients will not be able to see other patients. Only the therapist will be able to view and monitor multiple patients," said Prabhakaran Balakrishnan, the lead researcher on the project. "The therapist will also be able to pick one patient and work with him or her on a one-to-one basis."

In collaboration with Thiru Annaswamy, a physician and assistant professor of medicine, the 3-D tele-rehabilitation system will be deployed at the Dallas Veterans Affairs Medical Center and used to help rehabilitate disabled veterans, with field trials beginning in June.

"If the patient and the therapist cannot be in the same location," Venkataraman said, "we still want to be able to give that virtual experience of him or her being together with the therapist in the same room."

-- Aaron Dubrow, (
Investigators
Balakrishnan Prabhakaran
Ovidiu Daescu
Mark Spong
Xiaohu Guo
Gopal Gupta
Dinesh Bhatia
Roozbeh Jafari
Related Institutions/Organizations
University of Texas at Dallas
Dallas Veterans Affairs Medical Center

UNLICENSED DOCTOR, OTHERS CONVICTED IN $14.9 MILLION MEDICARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 

Wednesday, April 30, 2014

Detroit-Area Physical Therapist, Physical Therapy Assistant and Unlicensed Doctor Convicted in $14.9 Million Medicare Fraud Scheme

A federal jury in Detroit today convicted a physical therapist, physical therapy assistant and unlicensed doctor for their participation in a nearly $15 million Medicare fraud scheme.

Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the Detroit Office of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Office of Investigations made the announcement.

Shahzad Mirza, 43, a physical therapist; Jigar Patel, 30, a physical therapy assistant; and Srinivas Reddy, 38, a foreign medical school graduate without a license to practice medicine were each found guilty of one count of conspiracy to commit health care fraud in connection with a scheme perpetrated from approximately July 2008 through September 2011 at Detroit area companies Physicians Choice Home Health Care LLC (Physicians Choice), Quantum Home Care Inc. (Quantum), First Care Home Health Care LLC (First Care), Moonlite Home Care Inc. (Moonlite) and Phoenix Visiting Physicians.  In addition, Mirza and Patel were each found guilty of two counts of health care fraud in connection with the submission of false claims to Medicare for home health services, and Reddy was found guilty of three counts of health care fraud in connection with the submission of false claims to Medicare for home health services and physician home visits.  Patel was found guilty of one count of money laundering in connection with his laundering of the proceeds of the fraud through his company MI Healthcare Staffing.

The defendants were charged in a superseding indictment returned Feb. 6, 2012.  Three other individuals charged in the indictment remain fugitives.

According to evidence presented at trial, Physicians Choice, Quantum, First Care and Moonlite operated a fraudulent scheme to bill Medicare for home health care services that were never provided.  The home health care companies paid kickbacks to recruiters who in turn paid Medicare beneficiaries cash and promised them access to narcotic prescriptions.  The conspirators created the company Phoenix Visiting Physicians, which employed unlicensed individuals, including Reddy, to visit patients and provide them with narcotic prescriptions as well as obtain the information necessary to fill out paperwork to refer them for medically unnecessary home health care services.

Evidence presented at trial showed that beneficiaries pre-signed medical paperwork that was provided to Patel and other physical therapist assistants to fill in with false information purporting to show that the care was provided, when it was not.  Patel, registered physical therapist Mirza and others would sign this paperwork as though they had provided services.  In the course of the conspiracy, Patel incorporated his own staffing company, MI Healthcare Staffing, through which he laundered proceeds of the fraud from home health care companies and a shell company owned and operated by his co-conspirators.

Physicians Choice and the related companies were paid nearly $15 million in the course of the conspiracy.

Sentencing for all three defendants has not yet been scheduled.

The investigation was led by the FBI and HHS-OIG, and was brought by the Medicare Fraud Strike Force, a joint effort of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.  The case was prosecuted by Assistant Chief Catherine K. Dick and Trial Attorneys Matthew C. Thuesen and Rohan A. Virginkar of the Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

HEALTH CLINIC STRAW OWNER SENTENCED TO 30 MONTHS IN PRISON

FROM:  U.S. JUSTICE DEPARTMENT 
Tuesday, March 18, 2014
Straw Owner of Clinic Sentenced in Medicare Fraud Scheme

A Florida man who had been the straw owner of a physical therapy rehabilitation facility has been sentenced to serve 30 months in prison for his role in a $28.3 million Medicare fraud scheme.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney for the Middle District of Florida A. Lee Bentley III, Special Agent in Charge Paul Wysopal of the FBI’s Tampa Field Office and Acting Special Agent in Charge Brian P. Martens of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Florida region made the announcement.

Roberto Fernandez Gonzalez, 63, formerly of southwest Florida, was sentenced by U.S. District Judge Susan C. Bucklew in the Middle District of Florida and was ordered to forfeit $446,738 and pay the same amount in restitution.  Fernandez pleaded guilty on June 24, 2013, to conspiracy to commit health care fraud.

According to court documents, Fernandez and his co-conspirators used various physical therapy clinics and other business entities throughout Florida – including Rehab Dynamics Inc. in Venice, Fla. – to submit approximately $28.3 million in fraudulent reimbursement claims to Medicare from 2005 through 2009.   Medicare paid approximately $14.4 million on those claims.

Fernandez’s co-conspirators obtained and controlled Rehab Dynamics.   They engaged in a sham sale of Rehab Dynamics to Fernandez, a Cuban immigrant with no background in the health care industry.   Fernandez did not have the money to buy Rehab Dynamics.   Instead, the co-conspirators paid Fernandez approximately $20,000 to serve as the straw owner of Rehab Dynamics from January 2008 through March 2008.   During that time, Rehab Dynamics submitted approximately $1.6 million in fraudulent claims to Medicare seeking reimbursement for rehabilitation therapy services that were not provided.   Medicare paid approximately $446,738 on those false claims.

This case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Florida.   This case is being prosecuted by Trial Attorneys Christopher J. Hunter and Andrew H. Warren of the Criminal Division’s Fraud Section and Assistant United States Attorney Simon A. Gaugush of the U.S. Attorney’s Office for the Middle District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion.   In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.