Perhaps most of this Brooklyn story illustrates how medical treatments vary wildly from region to region, state to state, and — at times — even neighborhood to neighborhood. Physical therapists in Brooklyn tend to bill Medicare patients for more treatments than their counterparts elsewhere in country — and even elsewhere in New York City. On average, they billed each patient for 45 separate treatments in 2012, the Times analysis found. Across the river in Manhattan, the average was 37. In Connecticut, it was 24, while in Minnesota, it was a mere 13.
Mr. Bakry offers an explanation echoed by other practitioners: the newly released Medicare data paints an incomplete picture of where taxpayer dollars are actually flowing. In an interview, Mr. Bakry said his practice had about two dozen physical therapists and assistants working in four offices in 2012. The care provided by all of those therapists and assistants went under his Medicare billing number because he owned the practice.
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While Medicare has encouraged providers to bill under their own numbers, the agency acknowledges that data for some providers covers multiple practitioners. Mr. Bakry said he could never himself have provided all the treatments the data appears to suggest.
Furthermore, Mr. Bakry, who says he now operates three offices in different locations in Queens, says he has not worked out of the Ocean Avenue office for years — even though the Medicare data attributed his billings to that address.
"I don't know why they keep using that address," Mr. Bakry said.
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The release of the 2012 billing records this month set off a firestorm in the medical community. Many applauded the move, saying it shed light on the costs of health care and gave ordinary people a way to compare doctors and treatments.
But the American Medical Association and other industry groups fought against the release of the information. (The Obama administration released it after a long legal battle led by The Wall Street Journal.) The A.M.A. and its allies argued that the raw data provided patients with no information on quality of care.
And for practitioners like Mr. Bakry, who found themselves at the top of highest-billers list, the data thrust them into an uncomfortable public spotlight.
Whatever the case, as the nation's population ages and increasingly gets knees, hips and other joints repaired or replaced, demand for physical therapy treatments has been on the rise — and so has fraud. Billing for physical therapy services has come under heightened scrutiny by regulators and law enforcement in recent years, leading to numerous crackdowns and raids of physical therapy clinics around the country, including Brooklyn.
Those enforcement efforts have yielded big results. In 2011, a Brooklyn physical therapist pleaded guilty to submitting nearly $12 million in false and fraudulent claims to Medicare over more than five years. Last year, the owner of a Brooklyn medical clinic was sentenced to 15 years in prison for her role in a $77 million fraud in which patients were paid cash kickbacks to induce them to remain silent about services, including physical therapy, that were not provide, but were billed to Medicare.
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On average, physical therapists collected about $49,000 in Medicare payments in 2012, according to the data. Those reaping much more caught the eye of many experts scouring the data.
"The billing of some of these outliers — the thousands of hours of care that was provided — is it feasible to even bill that much service in a calendar year?" said Justin Moore, the vice president for public policy at the American Physical Therapy Association, which is doing its own analysis of the Medicare data and also noted the disproportionate number of high billers from Brooklyn.
"Even the ones who are billing hundreds of thousands of dollars start to raise some caution for us," Mr. Moore said.
Experts also expressed skepticism about the high number of treatments Mr. Bakry and other physical therapists in Brooklyn were providing their patients.
The 94 treatments Mr. Bakry's average patient received during the year were more than three times the national average. The second-highest biller in the country, which Medicare also listed under a Brooklyn address, also provided 94 treatments a patient, while the third-highest payee, yet another Brooklyn therapist, provided an average of 82 procedures a patient.
Mr. Bakry, noting that a physician must first approve a plan of treatment by a physical therapist before the therapist can be reimbursed, said that he stretched the patients' procedures over many visits and that he was doing what was needed to improve his patients' health.