The Insurance Fraud Bureau of Massachusetts assisted in this investigation
Walkyrie Massie, a/k/a Vicky Lopes, 39, the owner and operator of a Brockton physical therapy company, was sentenced this month in connection with her scheme to defraud insurance companies by providing falsified physical therapy services to insureds involved in car accidents.
“The scam perpetrated by Massie and her employees defrauded insurance companies and deprived injured patients of proper care,” said U.S. Attorney Carmen M. Ortiz. “Patients deserve quality care and insurance providers need honest care-givers. This kind of fraud is corrosive to our healthcare system.”
Massie, along with one of her employees, Edward Rossi, 65, of Rochester, were sentenced by U.S. District Court Judge Richard G. Stearns to 30 months and 18 months, respectively, coupled with two years of supervised release each for their actions. In addition, Judge Stearns ordered them to pay an additional $174,597 in restitution to the defrauded insurance companies. Massie and Rossi pleaded guilty to conspiracy to commit mail fraud and two counts of mail fraud in September and August of last year.
“Westgate Physical Therapy was solely motivated by profit rather than patient care when it forged patient records and billed for medical care never provided scamming private insurance companies out of hundreds of thousands of dollars,” said Vincent B. Lisi, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division. “The FBI is dedicated to aggressively investigating this type of criminal activity because it has a great impact not only on private insurance companies but on the economy as a whole as well.”
According to the authorities, Massie, as the owner and operator of Westgate Physical Therapy in Brockton, organized a scheme in which her employees would submit fraudulent medical progress notes to various insurance companies. The notes were submitted as proof of billing for physical therapy that had been given to Westgate patients who had been involved in car accidents.
For example, Rossi, a licensed physical therapy assistant, claimed to provide physical therapy to a number of his patients several times a week. When that treated was completed Westgate’s physical therapist, Deidre Chouinard, then re-evaluated said patient in order to sign-off that the treatment had been successfully completed. After that, Westgate would then bill the patient’s insurance company. The progress notes submitted would then be submitted to insurance companies in order to determine the appropriate personal injury protection payments. The notes were also used to determine whether any other bodily injury settlements existed with other insurance companies.
In reality, however, Rossi did not conduct this process. Instead, she simply filled in “cookie-cutter treatment notes for patients” many of whom either never appeared for their actual appointment or when did attend, attended for mere minutes. In many cases, Rossi never saw these actual patients because it was alleged he was not even present at the office on that day. Further evidence demonstrated, that Rossi also signed notes for treatments conducted by Westgate’s owner Massi, even though Rossi was not licensed to do so. The result was that through this fraudulent scheme, which occurred between 2009 and 2011, Westgate was able to bill various insurance companies more than $400,000 in false treatments. From that, the physical therapy office received more than $174,000 in illicit payments.
In many cases, Rossi simply filled in cookie-cutter treatment notes for patients who either never showed up that day, came into the clinic for mere minutes, or were not seen at all by Rossi because he was not present. Also, Rossi signed notes for treatments that Massie performed, even though she was not licensed to do so. Based on these fraudulent submissions, from 2009 to 2011, Westgate billed insurance companies more than $400,000 and received more than $174,000 in payments.
Much of the evidence of Westgate’s practices was gathered by federal law enforcement’s use of a cooperating witness. The witness went and sought treatment at Westgate claiming to have been in a car accident. During the time period of March through June 2011, the physical therapy office’s recordings and documents of this individual’s visits to Westgate demonstrated how the scheme was effected. In this specific case, Massie was caught boasting about he had forged the witness’ name to the sign-in sheets in order to falsely demonstrate that the witness had come in for specific treatments when in actuality he had not.
In addition, a conversation was recorded by the cooperating witness at Westgate. In that taped conversation, Rossi explains to the witness how the therapy exercise equipment worked to assure that the witness would be able to describe the physical therapy he never received if ever he were called by the insurance company to give a statement about his injuries and the treatment he received in response to them at Westgate.
While Massie and Rossi were both sentenced in January 2015, another employee, Westgate’s physical therapist, Chouinard, was sentenced to three years of probation in December 2014. A fourth defendant is awaiting trial.