Why is it important to ensure HIPAA and Medicare fraud training and auditing in your practice?
Here is a good example of what can happen:
Matthew Paul Brown, 30, formerly of Atlanta, Georgia and Nashville, Tennessee, pleaded guilty in federal district court to charges of health care fraud and wrongful disclosure of individually identifiable health information.
The United States Attorney Sally Quillian Yates said, "Medicare and Medicaid provide treatment for some of our community's most vulnerable citizens: the elderly, young children, and the financially needy. These vulnerable citizens deserve to be treated by medical personnel who have been duly trained and licensed and not by someone impersonating a doctor. This defendant's crime defrauded over a thousand people of the care they deserved and defrauded Medicare, Medicaid, and private health insurance companies of funds intended and needed for legitimate health care."
Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said: "The reckless conduct displayed by the defendant not only displayed a total disregard for the patients that he was improperly and illegally treating but also for those individuals who could have legitimately benefitted from the federal Medicaid/Medicare funds. The FBI works hard to ensure that these healthcare-based federal funds are used as intended and dedicates substantial investigative resources to bringing such activities as Mr. Brown's to justice."
According to United States Attorney Yates and the charges, from November 2009 through April 5, 2011, Brown carried out a health care fraud scheme in the metro Atlanta and Nashville, Tennessee areas. While operating in the Atlanta area, from November 2009 through August 2010, Brown approached numerous practicing physicians and persuaded them to bill Medicare, Medicaid, and private health insurers under their own provider numbers for allergy-related care provided by Brown. The care was provided both at the physicians' own offices and at health fairs, with the physicians agreeing to pay Brown between fifty and eighty-five percent of a total of approximately $1.2 million they received from the health care benefit programs. Brown has never been licensed in Georgia as a physician, physician assistant, nurse practitioner, or clinical nurse specialist.
The United States is not aware of any patients who were seriously injured by care received from Brown. Brown purchased the needles and allergy shots he used from a commercial pharmacy. The United States is not aware of any evidence that Brown ever used unsterile needles for the shots. The U.S. Attorney's Office has notified the individuals treated by Brown, to the extent it was possible to identify and locate them.
Brown also pleaded guilty to wrongful disclosure of individually identifiable health information, in violation of the Health Insurance Portability and Accountability Act ("HIPAA").
The individually identifiable health information wrongfully disclosed by Brown was a spreadsheet he created with information concerning each person he treated. Brown sent the spreadsheet to an undercover FBI agent, who Brown believed to be an investor considering a large investment in Brown's business.
Brown was indicted in April 2011. He pleaded guilty to the indictment today. The indictment charges 17 counts of health care fraud, each of which carries a maximum sentence of 10 years in prison and a fine of up to $250,000. The HIPAA charge also carries a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the Court will consider the United States Sentencing Guidelines, which are not binding but provide appropriate sentencing ranges for most offenders.
Sentencing for Brown is scheduled for November 22, 2011, at 11 a.m., before United States District Judge Amy Totenberg.
This case is being investigated by Special Agents of the Federal Bureau of Investigation.