Health Information Management

Strike Force arrests 243 for medical identity theft, healthcare fraud, false claims, kickbacks

HIM-HIPAA Insider, June 29, 2015

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The Medicare Fraud Strike Force swept through 10 states and arrested 243 people—46 of them physicians, nurses, and other licensed medical professionals—for allegedly defrauding the government out of $712 million in false Medicare and Medicaid billings, federal officials announced June 18. In addition to targeting instances of false claims and kickbacks, the strike force also uncovered evidence of medical identity theft.
 
Among the defendants is Mariamma Viju of Garland, Texas, an RN and the co-owner and nursing director for Dallas Home Health, Inc. A federal indictment accuses Viju and a co-conspirator of stealing patient information from Dallas-area hospitals in order to then solicit those patients for her business, as well as submitting false Medicare and Medicaid claims, and paying out cash kickbacks to beneficiaries.
 
In total, the scheme netted Viju $2.5 million in fraudulently obtained payments between 2008 and 2013. She was arrested June 16 and charged with one count of conspiracy to commit healthcare fraud, five counts of healthcare fraud, and one count of wrongful disclosure of individually identifiable health information.
 
The indictment says Viju allegedly took patient information from Baylor University Medical Center at Dallas, where she worked as a nurse until she was fired in 2012. Dallas Home Health then billed Medicare and Texas Medicaid for home health services on behalf of beneficiaries who were not homebound or otherwise eligible for covered home health services.
 
Viju also allegedly falsified and exaggerated patients’ health conditions to increase the amounts billed to Medicare and Medicaid, and thereby boost payments to Dallas Home Health. The indictment says she paid kickbacks to Medicare beneficiaries as well to recruit and retain them as patients of Dallas Home Health.
 
Viju’s co-conspirator—a co-owner of Dallas Home Health—wasn’t named in the indictment, but in a news release from the U.S. Attorney’s Office for the Northern District of Texas, that person was identified as her husband Viju Mathew. He’s a former registration specialist at Parkland Hospital in Dallas and pleaded guilty in November 2014 to one count of fraud and related activity in connection with identity theft.
 
Prosecutors say he used his position to obtain PHI, including names, phone numbers, birthdates, Medicare information, and government-issued health insurance claim numbers, so he could use it to contact prospective patients for his home health care business. He is due to be sentenced in August 2015.
 
In another case in Maryland, Harry Crawford—owner of RX Resources and Solutions—and two of his employees—Elma Myles and Matthew Hightower—are all charged with aggravated identity theft in addition to healthcare fraud and conspiracy to commit healthcare fraud.
 
An indictment from a federal grand jury accuses Crawford, Myles, and Hightower of fraudulently using actual names, addresses, and unique insurance identification numbers of numerous Medicaid beneficiaries to submit fraudulent claims totaling approximately $900,000 between 2010 and 2014.
 
The alleged scheme used Crawford’s durable medical equipment and disposable medical supply company to bill insurers for equipment and supplies that were never provided to beneficiaries, bill for amounts far in excess of the services delivered, and bill for supplies that weren’t needed and were never prescribed by a physician.
 
These are just two examples of the criminal fraud uncovered by the strike force.
 
In other cases, defendants face similar fraud and conspiracy charges for fraudulent billing schemes as well as charges for cash kickbacks, and money laundering, according to the Department of Justice (DOJ). The DOJ says more than 40 defendants are accused of defrauding the Medicare prescription drug program.
 
This was the largest coordinated takedown, in terms of defendants and money, in the history of the Medicare Fraud Strike Force, according to the DOJ. CMS also suspended licenses for several healthcare providers with authority granted to the agency under the Affordable Care Act.
 
Arrests occurred across California, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New York, Ohio, and Texas. Indictments on each case are available on the DOJ website.
 
This article appeared on HCPro’s HIPAA Update blog. Stay up to date on all things HIPAA by signing up for e-mail updates from this blog.



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