Posts Tagged ‘medical identity theft’
Medical Identity Theft on ABC News Good Morning America
This is a great clip about Medical Identity Theft and real people talking about their real case!
Remember, protect your valuable information, consider Entrust America when reviewing option of protection; the only product The Identity Advocate endorses. Entrust America
Preventing Medical Identity Theft – Palm Scanning
See the quick video about Palm Scans at El Centro Hospital:
Palm Scanning started at facilities back east. Good to see its arrival here in California. This procedure can assist in the prevention of Medical Identity Theft and Identity Fraud!
Department of Justice News and Strike Force Update Charges 94 doctors for $251 Million in Alleged False Billing
Department of Justice
Office of Public Affairs Press Release
WASHINGTON – Ninety-four people have been charged for their alleged participation in schemes to collectively submit more than $251 million in false claims to the Medicare program in the continuing operation of the Medicare Fraud Strike Force in Miami; Baton Rouge, La.; Brooklyn, N.Y.; Detroit and Houston, announced Attorney General Eric Holder, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, FBI Director Robert Mueller and Daniel R. Levinson, Inspector General of HHS. The operation announced today is the largest federal health care fraud takedown since Medicare Fraud Strike Force operations began in 2007.
The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. More than 360 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in today’s operation.
“Our continued Strike Force operations reflect the unprecedented commitment that inspired the creation of the Health Care Fraud Prevention and Enforcement Action Team in May 2009,” said Attorney General Holder. “With today’s arrests, we’re putting would-be criminals on notice: Health care fraud is no longer a safe bet. The federal government is working aggressively – and collaboratively – to pursue health care criminals around the country and to bring these offenders to justice.”
“Today’s arrests send a strong message that attempts to defraud Medicare will not be tolerated,” said Secretary Sebelius. “With the help of new tools in the Affordable Care Act, including stiffer penalties and better information sharing, we will continue to work with our federal, state and local partners to stamp out Medicare fraud and protect beneficiaries and the American taxpayer.”
Charges were unsealed today against 94 individuals who are accused of various Medicare fraud-related offenses, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of fraud schemes, including physical therapy and occupational therapy schemes, home health care schemes, HIV infusion fraud schemes and durable medical equipment (DME) schemes. Thirty-six defendants charged in these schemes have been arrested in Miami, New York, Baton Rouge and Detroit and additional arrests are expected throughout the day.
According to the court documents, the defendants charged today participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes, never provided. In many cases, indictments and complaints allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the treatments that, in reality, were unnecessary or never provided. Collectively, the doctors, health care company owners, executives and others charged in the indictments and complaints are accused of conspiring to submit more than $251 million in false claims to the Medicare program.
In Miami, 24 defendants were charged for allegedly participating in various fraud schemes that led to approximately $103 million in false billings. According to court documents, the fraud schemes involved fraudulent billing for HIV infusion services, home health care and physical therapy services, DME and pharmaceutical medications. The defendants include owners and operators of companies, doctors, nurses, and patient recruiters, as well as a medical biller who is alleged to have billed approximately $49 million for fraudulent services.
Thirty-one defendants were charged in Baton Rouge for various schemes allegedly involving fraudulent claims for DME totaling approximately $32 million. The defendants include the owners and operators of nine different purported medical services companies and four doctors, 14 patient recruiters and other individuals who allegedly worked at the medical services companies.
Twenty-two defendants were charged in Brooklyn for their alleged participation in schemes to submit fraudulent claims totaling approximately $78 million. These fraud schemes involved false billing for physical and occupational therapy and DME. The defendants include the owners and operators, patient recruiters and employees at three different purported medical clinics and a medical equipment company, as well as three doctors. According to court documents, six of the defendants charged are serial Medicare beneficiaries, who purported to seek medical treatment from numerous providers, causing the submission of multiple claims to Medicare for purported medical treatments.
In Detroit, 11 defendants were charged for their alleged roles in schemes to submit fraudulent claims to Medicare for home health services, nerve conduction tests and injection and infusion therapy sessions. The schemes involved a total alleged fraud of approximately $35 million and five different purported medical services companies.
Four defendants were also charged in Houston for their alleged roles in a $3 million scheme to submit fraudulent claims for DME.
In addition to making arrests around the country, law enforcement agents are executing search warrants in connection with ongoing health care fraud investigations.
“Today’s charges allege attempts by individuals to defraud the Medicare program of $251 million,” said FBI Director Robert S. Mueller, III. “Countless Americans rely on Medicare for their well-being, and the FBI, working in conjunction with our federal agency partners, is resolute in its commitment to stop those who would illegally manipulate the system.”
“Today’s arrests illustrate how health care fraud schemes can replicate virally and migrate rapidly across communities,” said Daniel R. Levinson, Inspector General of HHS. “To combat this fraud, the government’s response must also be swift, agile, and organized – a HEAT initiative goal which is well illustrated by today’s Strike Force actions.”
The Strike Force operations in Miami, Baton Rouge, Brooklyn, Detroit and Houston are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The HEAT task force, co-chaired by Acting Deputy Attorney General Gary G. Grindler and Deputy Secretary Bill Corr, is made up of top-level law enforcement agents, prosecutors and staff from both departments and their operating divisions. In the May 2009 announcement, Attorney General Holder and Secretary Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars. In December 2009, Strike Force operations were expanded to Brooklyn, Baton Rouge and Tampa.
Since its inception in March 2007 with Phase One in South Florida and continuing through its most recent expansion into Tampa, Fla., the Strike Force has obtained indictments of more than 810 individuals and organizations that collectively have billed the Medicare program for more than $1.85 billion. In addition, HHS’s 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.
The cases announced today are being prosecuted and investigated by Strike Force teams comprised of attorneys from the Fraud Section in the Justice Department’s Criminal Division and from the U.S. Attorneys’ Offices for the Southern District of Florida, the Eastern District of New York, the Middle District of Louisiana, the Eastern District of Michigan and the Southern District of Texas; and agents from the FBI and HHS-OIG.
The Railroad Retirement Board Office of Inspector General and the Office of Personnel Management-Office of Inspector General also participated in today’s operation.
An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.
To learn more about the HEAT team, go to: www.stopmedicarefraud.gov.
Identity Theft of the Dead
I tell you the dead are not safe from Identity theft. Read the following FBI press release.
Doctor Pleads Guilty to Billing Medicare and Medicaid for Counseling Sessions with Dead Patients
Dr. Williams Claimed $2 Million in Phony Health Treatments, Saying It Was Group Therapy
U.S. Attorney’s Office June 06, 2011
Northern District of Georgia (404) 581-6000
ATLANTA—ROBERT WILLIAMS, 72, of Atlanta, Georgia, pleaded guilty today in federal district court on two counts of health care fraud as part of a scheme to bill for group psychological therapy that WILLIAMS never provided.
United States Attorney Sally Quillian Yates said, “With so many elderly citizens and others who need specialized psychological care, this defendant ignored his duty as a doctor and became a billing machine who claimed to treat patients who were in fact dead. This blatant attempt to rip off the system took funds and care away from real live patients with real problems. Medicare and Medicaid need all the money they can get for legitimate patient care and this physician will get none of that money.”
“This case sends a strong message that Medicare and Medicaid fraud will not be tolerated in Georgia,” said Georgia Attorney General Sam Olens. “At a time when our state budget is heavily strained, every dollar intended for the needy must reach the recipient. We will continue to work with our partners, the U.S. Attorney’s Office, and the FBI, to weed out fraud in Georgia.”
Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said, “Dr. Williams had for years, enjoyed a position of trust within the medical and health provider industry. He chose to abandon that trust and instead displayed a level of greed that will not be tolerated. Medicare fraud should be promptly reported to the nearest FBI field office so that the much needed federal health care benefits will be there for those individuals who truly need them.”
According to United States Attorney Yates, the charges, and other information presented in court: WILLIAMS was a licensed physician, practicing in the Atlanta area. From approximately July 2007 through October 2009, he contracted with a medical services company to provide group psychological therapy to nursing home patients in a variety of nursing homes. Under his signature, thousands of claims were submitted to Medicare and Georgia Medicaid seeking reimbursement for group psychological therapy that WILLIAMS purportedly provided to beneficiaries at several nursing homes in the Atlanta area. In many instances, however, WILLIAMS did not actually provide the therapy.
Specifically, from July 2007 through October 2009, Medicare claims data indicated that over 55,000 claims were submitted using WILLIAMS’ provider number for group psychological therapy. Those claims sought reimbursement for over $2,000,000, and ultimately caused Medicare to reimburse WILLIAMS over $750,000. For the same time period, over 40,000 Medicaid claims were submitted by WILLIAMS for group psychological therapy, causing Georgia Medicaid to pay out over $225,000.
An investigation of WILLIAMS’ claims showed that, in many cases, he sought payment for services provided to beneficiaries who were deceased at the time he purportedly rendered the care. In two cases, the patient died over a year before he was allegedly seen by WILLIAMS in the nursing home. Numerous claims were submitted to Medicare and Medicaid for group psychological therapy when the beneficiary was hospitalized at the time of service and, consequently, could not have received care at the nursing home as represented.
WILLIAMS was indicted on February 22, 2011 on 10 counts of health care fraud. Today WILLIAMS pleaded guilty to two of those counts. He could receive a maximum sentence of 10 years in prison and a fine of up to $250,000 for each count. 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 has been scheduled for August 23, 2011, at 11:30 a.m. before United States District Judge Richard W. Story.
This case is being investigated by special agents of the Federal Bureau of Investigation and the Georgia Medicaid Fraud Control Unit.
Assistant United States Attorneys Kurt R. Erskine and Nick Oldham, and Senior Assistant Attorney General Nancy Alstrom from the Georgia Medicaid Fraud Control Unit, are prosecuting the case.
For further information, please contact Sally Q. Yates, United States Attorney, or Charysse L. Alexander, Executive Assistant United States Attorney, through Patrick Crosby, Public Affairs Officer, U.S. Attorney’s Office, at (404) 581-6016. The Internet address for the HomePage for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.
Patient Privacy Rules from HHS
Health and Human Services has establish more patient privacy rules. See article at Employee Benefit News:
http://ebn.benefitnews.com/news/medical-records-privacy-rule-2713970-1.html?ET=ebnbenefitnews:e1658:1666561a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=EBN_inBrief_060111#
Terrific news clip on Medical Identity Theft
Beware as more people see desperate times and the cost of healthcare rises. Watch this quick video and take head of their advice:
LifeLock refunds nearly One Million Consumers as part of Nationwide Settlement
LifeLock will refund consumers in 34 states $10.87 as part of an FTC settlement for misleading advertising practices. Not being able to provide “guaranteed” protection from medical identity theft or employment information theft and no protection against misuse of current their existing account information, the FTC settlement was reached in March of this year. Read the Consumer Affairs.com article at: http://www.consumeraffairs.com/news04/2010/11/nearly-one-million-consumers-getting-refunds-from-lifelock.html
Data Breeches in Health Care
Data Breeches are costing millions each year. The HITECH Act has not changed data protection as first thought. Dr. Larry Ponemon from the Ponemon Institute (which conducts independent research on privacy, data protection and information security policy) has submitted a great blog on the statistics which is available at : http://www.ponemon.org/blog/post/poor-privacy-practice-is-ailing-healthcare-industry
Medical Identity Theft – It can happen to you!
Think again if you believe Medical Identity Theft can’t happen to you. Watch this news clip from ABC news and Good Morning America:
Electronic Health Records – Reducing Mistakes – or added fear of Medical Identity Theft
Keeping your own personal health records is critical when it comes preventing Medical Identity Theft. This record can be paper or electronic. Also there are a number of online solutions. The American Health Information Management Association can help you in creating your own records. Their web site is www.myphr.com. Portable storage devices, CD’s or flash drives even a smart phone can be used to create your electronic record. The disadvantage is it may be lost or damaged and physician offices may not be able to read your records.
The following components should be included: Personal identification; emergency contacts (including phone numbers); health care providers (including specialists, dentists, pharmacists and their phone numbers); health insurance information; living will, advanced directives or power of attorney; organ donor authorization; current medications and dosages; allergies; immunizations; significant surgeries or illnesses; results from recent exams; and family history.
There are a number of resources and advocacy groups that help patients navigate the health care systems, an example being Guardian Nurses Healthcare Advocates.
If you have your own information always available to you, if someone tries to steal your medical identity you have your own records that are up to date and safe in your hands, thus preventing the HIPAA nightmare of trying to change what never really belonged to you. Be proactive in your health and all records involved with your care.



