A 69-year-old man from Mexico recently pleaded guilty and was sentenced to time served (26 months) after being arrested in 2017 and indicted for illegal re-entry and identity theft. He was accused of using the stolen identity (Social Security Number and name) of a U.S. citizen in order to obtain medical care in a New York hospital and a nursing home and bill providers (possibly Medicare/Medicaid) for that care.
In pleading guilty, the defendant acknowledged that in October 2016, he was admitted as a patient to a New York hospital. At that time, he identified himself by using a stolen identity and Social Security Number. He knew when he made those statements that the Social Security Number that he presented was not his own and was assigned to another person. He made the false representations for purposes of billing for his medical expenses and to use the number to receive care at the hospital. The defendant was later admitted to a nursing home where he again provided a false name and Social Security Number for the purposes of billing for medical expenses and obtaining care. The defendant was provided medical care by both facilities, resulting in unpaid charges of slightly more than $1 million.
He has been ordered pay restitution of $127,739.32 to the nursing home and $946,801.83 to the hospital. After being sentenced, the man was taken into custody by the Department of Homeland Security on an immigration detainer. He faces further civil proceedings in Immigration Court.
Compliance Perspective
Admitting a resident based on a stolen identity, e.g., Social Security Number and name, may result in a loss of reimbursement for care provided and be considered submission of false claims, in violation of state and federal regulations.
Discussion Points
- Review policies and procedures regarding protocols for ensuring that persons seeking admission into the facility have valid identifying information and are not using a stolen identity.
- Train staff regarding the facility’s protocols to ensure that only qualified beneficiaries are admitted based on verification of their Medicare numbers, not just by providing a Social Security Number (SSN). Consider requiring valid photo identification. Train staff to report suspicious incidents of possible identity theft to authorities or through the Hotline.
- Periodically audit recent admissions to determine if the identity information provided seems inconsistent or suspicious. Authentication of identity-based SSN Verification, Social Security Administration Death Master Files, and Identity Usage & Address History can be conducted at this website: https://www.theworknumber.com/socialservices/.
FOR MORE INFORMATION ON THIS TOPIC: IDENTITY THEFT: DETROIT MAN STEALS 1000 IDENTITIES
