A 46-year-old Texas man was taken into custody on charges of healthcare fraud and aggravated identity theft in connection with a scheme to defraud the Texas Medicaid Program, US Attorney Alamdar S. Hamdani announced on September 13.
The indictment alleges the defendant submitted or caused the submission of over 15,000 fraudulent claims to Medicaid for services that were never provided. Between 2018 and 2022, the claims resulted in approximately $2 million in Medicaid payments, according to the charges. The indictment further alleges he used the personal information of Medicaid beneficiaries without their consent to facilitate the fraudulent billing scheme.
According to the charges, the defendant submitted claims under his national provider identifier number, representing that he provided counseling services at his office in Brownsville. However, he allegedly never actually rendered those services. The indictment details multiple instances in which he unlawfully used Medicaid beneficiaries’ identities in the fraudulent claims.
The defendant is charged with 10 counts of healthcare fraud, each carrying a maximum sentence of 10 years and a fine of up to $250,000. Additionally, he faces three counts of aggravated identity theft, with a mandatory two-year prison sentence that must run consecutively to any other sentence imposed.
Compliance Perspective
Issue
Nursing facilities are obligated to protect residents from financial abuse and exploitation, ensuring that residents’ personal identifiable information (PII) remains confidential. Misuse of public funds is considered fraud, waste, and abuse. Submitting false claims to Medicare or Medicaid is illegal and may result in fines of up to three times the programs’ loss plus $11,000 per claim filed. Under the civil False Claims Act, each false claim is subject to these penalties, and reporting suspicious billing practices is mandatory.
Discussion Points
- Review your policies and procedures on protecting residents’ PII and preventing financial abuse and exploitation. Also review your policies and procedures for preventing and reporting a false claim. Update your policies if needed.
- Train staff with access to residents’ PII on protecting this information and on compliance with your policies. Provide comprehensive training on compliance and ethics policies to all staff upon hire and at least annually. This training should cover the identification and reporting of fraud, waste, or abuse, including reporting procedures. Document all training sessions and maintain signed records in each employee’s education file.
- Conduct regular audits to ensure staff are knowledgeable about procedures for protecting PII and their responsibilities in reporting compliance and ethics concerns. Perform audits to confirm that staff understand the importance of reporting violations to supervisors, the compliance officer, or via the anonymous hotline.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
