Highlights of recent compliance-related enforcement are summarized below. Recent enforcement focuses on home health, criminal theft of patient information, and Medicaid personal assistants.
Hospital employee who stole patient information pleads guilty
A former employee of a Dallas hospital pleaded guilty to federal offenses involving his theft of hospital patient information. The employee’s job was to enter patient information into the hospital computer system. The employee obtained patient names, phone numbers, DOB, Medicare status, and claim numbers with the intention of contacting these patients to market his home health care business. He faces up to 5 years in federal prison and a $250,000 penalty. Do your HIPAA policies include controls to prevent employees from committing unauthorized access of patient information?
MO and IL personal assistants head to jail
- A Missouri woman was sentenced to 15 months in federal prison on health care fraud charges. The woman was working as a Medicaid personal assistant under the Illinois Home Services Program. She was accused of billing Medicaid for hours of care when she did not in fact provide the care--including occasions when the patient was in the hospital.
- An Illinois man faces 10 years in prison and up to $250,000 in fines after pleading guilty to fraudulently billing the Illinois Home Services Program for personal assistant services. The individual allegedly falsified time sheets, enabling his girlfriend/personal assistant to receive Medicaid payments while she was in jail.
Home health settlements, guilty pleas and convictions
- A Tennessee-based home health company entered a $25 million False Claims Act settlement. The company allegedly "overstated the severity of patients' conditions to increase billings and billed for services that were not medically necessary and rendered to patients who were not homebound." This case was brought by a whistleblower, who will receive more than $3.9 million as his reward for assisting with the lawsuit.
- A home health company owner is headed to prison for her role in a $74 million Medicare fraud scheme. She pleaded guilty to conspiracy to commit health care fraud, received an 80 month prison sentence, and must repay $45 million to the government. She admitted to:
- Billing Medicare for PT and home health services that were medically unnecessary or never provided.
- Paying kickbacks to recruiters who sent her patients, prescriptions, plans of care and certifications, which were used to fraudulently bill Medicare.
- A jury convicted two home health company owners, and an adult day care operator, for their roles in a $29 million Medicare fraud plan. All parties were convicted of conspiracy to commit health care fraud, plus other charges. The evidence showed that:
- The adult day care center billed Medicare for mental health services provided by unlicensed staff.
- The home health companies billed Medicare for services that were unnecessary or never provided, and fabricated medical records to cover it up--and later burned the false records.
- A home health company owner gave the adult day care operator kickbacks in exchange for patient information that home health used to bill Medicare for fictional home health services.