A Mississippi man conspired with other individuals to provide fraudulent statements to Medicare for reimbursements of claims for patient treatment and prescriptions. The events took place between January 2016 through March 11, 2019, during which time the man claimed to be a licensed physician in the state of Mississippi. He was not licensed to practice medicine in Mississippi or in any other state.
The defendant treated patients, ordered diagnostic testing and laboratory work, and prescribed medications while he was employed at a Mississippi neurology clinic. Using his co-conspirators, he submitted documents seeking reimbursement for the provided services under another co-conspirator’s Medicare identification number. Medicare reimbursed for the services and prescriptions, believing the services were provided by a licensed physician.
The defendant pled guilty in December 2021, and was sentenced in April 2022 to 30 months in prison. He was also ordered to pay restitution of $1,537,326.14 for providing false statements in connection with the delivery of payments for healthcare benefits to Medicare beneficiaries.
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. Where required, drug screens are also necessary. 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. Routine monitoring will ensure that employees are legally permitted to practice healthcare in your facility.
Discussion Points:
- Review your policies and procedures on preemployment and regular monitoring of employee checks. Update your policies as needed.
- Train appropriate staff on your policies and procedures for employee checks. Document that the trainings occurred, and file each signed document in the employee’s education file.
- Periodically audit to ensure that all preemployment checks have been completed and that regular monitoring is ongoing.
