A federal jury in Texas convicted a 65-year-old foreign medical student for conspiracy to commit healthcare fraud. At the trial, a co-conspirator testified that she owned numerous home health agencies in the Houston Area. She admitted she hired the defendant to act in the role of a physician to see patients in their homes. The defendant did not have a license to practice medicine in the United States and was also not under the supervision of a physician when he treated patients.
The co-conspirator further testified that the defendant visited patients and qualified them for home health, when in fact, they did not need services. In addition, recruiters were paid to provide patient information to bill them for home health services regardless of whether they needed care.
At the trial, the defendant attempted to convince the jury he had no knowledge of fraud and did not have the intent to defraud Medicare. He testified that he was merely seeing patients for the co-conspirator, despite not having any medical license in the United States and without being supervised by a physician.
The jury did not believe the defense claims and found him guilty as charged. The defendant faces up to 10 years in prison and a possible $250,000 fine. Previously released on bond, the defendant was taken into custody following the conviction where he will remain pending that hearing. The co-conspirator was previously convicted and is currently awaiting sentencing.
Issue:
Healthcare settings are required to conduct extensive background checks on all employees. These should be comprehensive in order to ensure that each potential employee is qualified and permitted to be employed in a healthcare facility that receives government funds. Before an employee is officially hired into a position, a criminal background check and sex offender registry search must be completed, and the individual must be cleared in the databases. Additionally, an identification verification check, past employment history, education verification, and OIG federal exclusion list check must be completed for all employment candidates. For positions that need certifications or licenses, verification of these credentials must be conducted and documented in the individual’s personnel file. After hire, it is essential that the databases are continually monitored to ensure that no current employee has recently been placed on an exclusion list or had a license or certification suspended or revoked. Routine monitoring will ensure that employees are legally permitted to practice healthcare in your facility.
Discussion Points:
- Review policies and procedures for verifying the status of professional licenses. Update as necessary.
- Train appropriate staff to follow protocols for verification of licenses and certifications of employees at the time of hire and on an ongoing basis to ensure that those licenses remain up-to-date and are unencumbered. Ensure that training is provided to licensed personnel about their responsibility to maintain an active license and to notify administration should their license be suspended, expire, or if they are added to the OIG’s LEIE. Document that these trainings occurred, and file the signed documents in each employee’s education file.
- Periodically audit to verify that the licensing and certifications of employees are valid and up-to-date. Immediately address any negative findings.
