Saint Paul Physical Therapist Charged in $102K Medicaid Fraud
BY MN CRIME STAFF
A 54-year-old woman is facing four felony counts after state investigators say she fraudulently billed Minnesota’s Medicaid program for more than $100,000.
Authorities allege the woman billed for physical therapy services that were never provided or couldn’t have occurred within the timeframe patients were at her Saint Paul clinic.
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Tammy Lynn Saphir, of Maple Grove, is charged with four counts of theft by false representation tied to alleged Medicaid fraud spanning from January 2020 through July 2021. Prosecutors say the scheme resulted in more than $102,000 in improper payments.
According to the criminal complaint filed earlier this week in Ramsey County District Court, Saphir is a licensed physical therapist who worked at Lexington Rehabilitation Center in Saint Paul. Investigators with the Minnesota Attorney General’s Office Medicaid Fraud Control Unit allege Saphir worked with clinic and billing staff to submit false claims for reimbursement through Minnesota’s Medical Assistance program. The claims were paid by UCare, a managed care organization that administers Medicaid benefits on behalf of the state.
Authorities say the fraudulent billing involved multiple methods. Investigators allege Saphir routinely billed for more units of therapy than could have been provided based on the amount of time patients were present at the clinic. In some cases, claims reflected far more therapy minutes than were possible during a patient’s documented visit. In other instances, claims were submitted for services that investigators say did not occur at all.
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The complaint outlines several specific examples. On June 25, 2021, Saphir allegedly billed three units of therapy for a patient who was only present long enough to receive one unit. On that same day, investigators say she overbilled multiple other patients, resulting in Medicaid paying for services that could not have been delivered during the documented time frames. Similar patterns were identified across dozens of dates over an 18-month period.
Investigators also allege Saphir improperly billed Medicaid as if she personally provided services that were actually performed by a physical therapist assistant or aides. Under Medicaid rules, services performed by an assistant must include a billing modifier that reduces the reimbursement rate. Authorities say that modifier was routinely omitted, resulting in higher payments as if the work had been done by a licensed physical therapist.
A former physical therapist assistant interviewed during the investigation told authorities that patient appointments often overlapped and that Saphir indicated it was acceptable to bill certain treatments in ways that increased reimbursement. Investigators say billing records showed thousands of therapy units billed during time periods when it would have been impossible to deliver the services claimed.
The charges are broken down into four date ranges, each tied to a specific dollar amount. Prosecutors allege Saphir caused Medicaid to pay approximately $7,800 for January 2020, more than $36,000 between February and July 2020, nearly $40,000 between August 2020 and January 2021, and just under $19,000 between February and July 2021. Combined, the total alleged loss is $102,912.74.
Each count is a felony theft by false representation charge. Two of the counts allege thefts exceeding $35,000, which carry a maximum possible sentence of 20 years in prison and a $100,000 fine. The remaining two counts allege thefts exceeding $5,000, each punishable by up to 10 years in prison and a $20,000 fine.
Court records show Saphir was summoned to appear in court and a booking photo was not yet available as of publication. Her first appearance is scheduled for Jan 23.
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