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From the CRC Blog: Identity theft

Credentialing & Verification Update, November 11, 2008

I was curious about the FTC’s and other federal agencies regulations requiring compliance with The Red Flag Identity Theft Rules. At first I didn’t think it applied to hospitals but further explanation clarified that “organizations providing services on a deferred payment basis would be considered “creditors” and, therefore, would be included in the new regulations.

As my mind often wanders when reading such interesting articles, I recalled a recent event when an employee had her identify “stolen” which resulted in her employer being ordered by the court to withhold her salary. Fortunately the employee was able to prove in court that she was not the individual who had committed the fraud and her salary was returned to her. Does this happen to physicians? Do they have to worry about identify theft?

It should not be a surprise to MSPs that there are many instances of Medicare fraud. One story relates information being collected from physicians under the guise of a CMS file update. This information was then used to submit false Medicare claims. For example Mailee Renae Lodge, AKA Mailee Renae Reed, was ordered to pay $1.3 million in restitution and was sentenced to 5 years in prison for billing for home examinations, sleep studies and pulmonary studies using stolen provider ID to fraudulently bill.

In another example, California’s state Medicaid program was defrauded $3.9 million by the use of physicians’ stolen identities. Some of the criminals were arrested and charged but often the perpetrators are never found.

Worried about identity theft? I’ll bet your physicians are.

Carole La Pine, MSA, CPMSM, CPCS is the Manager for Physician Services at Trinity Health in Novi, MI. Carole has more than 30 years of experience in the medical staff services profession and is a past president of National Association Medical Staff Services (NAMSS). Read more from Carol at the Credentialing Resource Center Blog.

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