A woman who committed healthcare fraud by posing as a licensed physician’s assistant has been sentenced to two years, nine months in federal prison, followed by three years supervised release, US Attorney Ryan K. Buchanan announced on April 18, 2023. In addition to the sentencing, she was ordered to pay restitution in the amount of $48,742.30. US Attorney Buchanan said the woman had previously served prison time for similar conduct.
According to US Attorney Buchanan, the charges, and other information presented in court: On or about September 24, 2019, the woman was hired as a licensed physician’s assistant at a family practice in Georgia. She was not a licensed physician’s assistant in Georgia at that time, nor had she been in any state since March 2014. After she had served a prison sentence for a 2015 fraud and narcotics case related to her illegal practice as a physician’s assistant in the State of Mississippi, she relocated to Georgia and again obtained employment, posing as a licensed physician’s assistant at the family practice where she’d been employed before.
While employed there, she treated patients, diagnosed illnesses, ordered diagnostic tests and lab work, and handled sick visits and prescribed drugs to patients — none of which was authorized by law based on her lack of licensure and exclusion from federal healthcare programs. She also issued prescriptions, including prescriptions for controlled substances, in the name of a physician contracted by the practice, and without the physician’s permission. She caused the practice to submit approximately $147,000 in fraudulent claims for reimbursement to Medicare and numerous private insurance companies.
Compliance Perspective
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’s List of Excluded Individuals and Entities (LEIE) 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 since the last check. 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 and monitoring the OIG’s LEIE. 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 and that OIG LEIE checks are routinely conducted. Immediately address any negative findings.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
