Healthcare Compliance Perspective:
Auditors must not only look at pink and red flags involving one risk exposure, but look at all risk exposures together to recognize patterns or, in the matter below, conspiratorial collaboration in seemingly disparate areas.
A former employee at a Dallas hospital and his wife, a registered nurse who worked at another Dallas area hospital – both of whom had earlier pled guilty to federal charges of theft and unlawfully obtaining patient identification information, were sentenced to 30 months in prison and ordered to pay $297,957.89 in restitution to Medicare today by a U.S. District Judge.
The man pled guilty in November 2014 to one count of fraud and related activity in connection with identification documents, authentication features and information
(identity theft). His wife pled guilty in May 2016 to one count of wrongful disclosure of individually identifiable health information (HIPAA violation). Both defendants reside in Garland, Texas. The judge ordered them surrender to the Bureau of Prisons on August 30, 2017.
The couple were charged with stealing patient identities from their jobs at local hospitals and using the stolen patient information to solicit patients for the home health care agency they jointly owned and operated. The man worked as a registration specialist and was responsible for entering patient information into the hospital’s computer system. He used his position to obtain confidential information for more than 3,000 patients, including patients’ names, telephone numbers, dates of birth, participation in the Medicare program, and government-issued health insurance claim numbers. The woman worked as a registered nurse until she was terminated in October 2012. While employed, she secretly collected patient identification information, specifically, identifying health information, to recruit them as patients of the home healthcare facility the couple owned and where she served as the Director of Nursing.
According to the evidence, the couple obtained patient certifications from a number of doctors who have been convicted or charged in other health care fraud cases in the Northern District of Texas.
