A 49-year-old Texas physician assistant was arrested and charged for his role in a scheme to defraud Medicaid by working with a suspended medical license. On July 20, 2021, the Texas Medical Board allegedly ordered the immediate suspension of his physician assistant license, deeming him to be a “continuing threat to public welfare.” He was then prohibited from practicing medicine, according to the charges.
However, the physician assistant allegedly continued to evaluate and treat patients at mental health clinics in three cities and billed Medicaid for services he rendered during his suspension.
The indictment further alleges that the physician assistant attempted to conceal his continued practice of medicine by using identities of other physicians and medical personnel. Specifically, he allegedly created medical records under the identities of other physicians while they were traveling outside of the United States. The charges also allege he submitted false statements to the Texas Medical Board in an effort to conceal his improper practice of medicine.
The physician assistant is charged with seven counts of healthcare fraud for which he faces up to 10 years in federal prison. If convicted of any of the four aggravated identity theft charges, he faces another two years which must be served consecutively to any other prison term imposed. All counts also carry a possible fine of up to $250,000.
The FBI, Department of Health and Human Services-Office of Inspector General, Texas Health and Human Services and Texas Attorney General’s Medicaid Fraud Control Unit, and Department of Homeland Security-Office of Inspector General conducted the investigation.
Issue:
Unlicensed individuals or those with a suspended license may not bill directly for treating Medicare and Medicaid patients, nor may their services be billed indirectly through an employer or a group practice. Facilities are responsible for ensuring that they do not employ or contract with excluded individuals or entities, whether in a physician practice, a clinic, or in any capacity or setting in which federal and state healthcare programs may reimburse for the items or services furnished by those employees or contractors. This responsibility requires screening all current and prospective employees and contractors against OIG’s List of Excluded Individuals and Entities. Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). To avoid CMP liability, healthcare entities should routinely check the list to ensure that new hires and current employees are not on it.
Discussion Points:
- Review your policies and procedures for screening of potential employees to confirm that they are not included on a state or OIG exclusion list. In addition, review your policies and procedures for frequency of checking the OIG Exclusion List for all current employees and vendors. Update policies as necessary.
- Train all appropriate staff on the requirement for checking the OIG LEIE link for all new potential hires, current employees, and vendors, and the frequency for repeating the checks. Document that the trainings occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure that all new employees have been confirmed as not being on the OIG LEIE. Also, determine that routine checks are being conducted for current employees to ensure that they have not been added to the OIG Exclusion List. Ensure that a copy of the OIG LEIE screening confirmation is included in each employee or vendor file.
