On April 30, 2018, the U.S. Attorney’s Office in the District of Massachusetts reported the criminal conviction of Rita Luthra, M.D., a Springfield, Massachusetts gynecologist for one count of violation of the HIPAA Act and one count of obstruction of a criminal health care investigation. Sentencing has yet to be scheduled. The HIPAA criminal charges stemmed from the allegation that Dr. Luthra allowed a Warner Chilcott pharmaceutical sales representative to access her patients’ medical files.
October of 2015, Warner Chilcott entered a false claims settlement with the federal government. Warner Chilcott agreed to pay $125 million to resolve its criminal and False Claims Act allegations related to the company’s drug marketing campaign. Warner Chilcott was charged with paying kickbacks to physicians to induce them to prescribe its drugs, and manipulating prior authorizations to get insurers to cover the drugs they would not normally cover.
Dr. Luthra was receiving “numerous” denials for a Warner Chilcott osteoporosis medication unless there was a prior authorization. To expedite the prior authorization process, the Warner Chilcott sales representative was given access to Dr. Luthra’s medical records in order to prepare the prior authorizations that would then be signed by Dr. Luthra.
Criminal convictions as a result of a HIPAA violation do happen occasionally. In addition to OCR fines and penalties, criminal charges and convictions can occur when covered entities “knowingly” obtain or disclose protected health information in violation of HIPAA. MPA recommends including examples of both civil and criminal HIPAA violations and penalties in your HIPAA training program.
Kickbacks can be one of the hardest skilled nursing compliance risk areas for employees to recognize—especially for employees who are new to health care. Kickbacks also bring some of the largest OIG compliance penalties for providers.