A 48-year-old Texas woman was sentenced to 56 months in prison to be immediately followed by two years of supervised release for defrauding Medicaid of more than $600,000, announced US Attorney Alamdar S. Hamdani on November 13, 2023. At the hearing, the court heard how the defendant fraudulently obtained the information of over 300 patients. They also heard about the defendant’s attempts to conceal her crimes and that she appeared to be searching for more employment opportunities to steal more information. In handing down the sentence, the court noted the defendant’s “cunning and calculated” actions as well as her “greed and selfishness” and how she manipulated everyone around her.
The defendant was the former office manager for her ex-husband—a therapist and Medicaid provider in the Houston area. Following their separation, the defendant admitted to using her ex-husband’s provider number to submit fraudulent claims to Medicaid, unbeknownst to him, for counseling services that were never provided.
In 2017, the defendant admitted to using her employment at a pediatrician’s office to obtain patient information. She then submitted more fraudulent claims to Medicaid under her ex-husband’s provider number.
In total, from 2013 until 2018, the defendant submitted, or caused the submission of, approximately $617,983.86 in claims for psychotherapy services that were not provided. She admitted she was paid approximately $432,924.69 for those claims.
Compliance Perspective
Issue
It is the responsibility of every facility to take the required precautions in keeping residents’ personal information as confidential as possible, to protect residents from financial abuse and exploitation. Facilities should ensure that residents’ information is only being accessed when it is necessary for medical or billing purposes. As identity theft rises across the country, it is important that facilities protect residents’ personal information, while keeping in mind that residents are more likely not to know that they have been a victim of identity theft.
Discussion Points
- Review your policies and procedures on protecting residents’ personal information and preventing financial abuse and exploitation. Update your policies if needed.
- Train all staff who have access to residents’ personal information on your policies and procedures for protecting residents’ personal information. Train all staff on your policies and procedures for preventing financial abuse and exploitation. Document that these trainings occurred, and file the signed document in each employee’s education file.
- Periodically audit to ensure that staff who have access to residents’ personal information are aware of the proper procedures to follow to prevent personal information exposure. Also, periodically audit staff to ensure that they are aware of what constitutes financial abuse and exploitation, and that they know what to do if they suspect financial abuse or exploitation is occurring.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
