HOw i FOund MYSELF EnTAngLEd in MEdiCAL idEnTiTY THEFT
Health Care law Section Chairs: T. J. Ferrante – Foley & Lardner LLP & Kevin Rudolph – Shriners Hospital for Children
i learned that the consequences of medical identity theft for providers can be severe even when a provider has done nothing wrong.
© Can Stock Photo / gubcio
The year 2013 was a big one. After accruing substantial medical school debt and enduring residency, I finally became a licensed physician. With a year of residency remaining, I responded to an ad to supervise physician assistants in South Florida. The job entailed fielding clinical questions, co-signing charts, and ordering medical equipment for 40 house-bound patients.
Shortly after beginning, I received mail that other providers had prescribed my patients interacting medications or nearly identical drugs to what they were already taking. I went to the clinic to talk with the manager and physician assistants about my concerns. They told me they would address the problems, but no changes were made. Four months after starting, I realized the patient management wasn’ t going to improve, so I handed in my resignation. I cited conflicts with my other job. As a favor to the manager, I agreed to review one more month of charts while a replacement was found.
Days later, I received news no physician wants to hear— the clinic I was working for was being investigated for fraudulently billing Medicare. After I cooperated with the investigator, he requested that I not notify the clinic of the investigation. At this point, I decided to hire an attorney.
Based on my attorney’ s advice, I immediately resigned from my position at the clinic, citing concerns over the clinic’ s billing practices. This strategy worked, and I never heard from the company again.
Since my interaction with the clinic, I have been contacted by investigators on five separate occasions about prescriptions written in Miami, even through I work in Tampa. Investigating parties have included the FBI, police detectives, pharmacies, and Medicare contractors. The perpetrators of these fraudulent schemes have managed to escape discovery by opening and closing new pharmacies faster than they can be investigated.
From this experience, and after speaking with my attorney,
I learned that the consequences of medical identity theft for providers can be severe, even when a provider has done nothing wrong. Providers’ national provider identifiers( NPIs) and Drug Enforcement Administration numbers are easy prey for thieves. NPIs are publicly available on the National Plan and Provider Enumeration System, and DEA numbers are listed on every page of a physician’ s prescription pad.
To limit the occurrence of future thefts or significant loss, providers should do the following:
• Avoid giving identifiers to potential employers before taking the time to learn about the potential employers.
• Be aware of billings in your name, paying close attention to any organization you have reassigned billing privileges to.
• Monitor mid-level provider activities and charting to ensure that documentation supports billed services.
Continued on page 27
Not Receiving Emails from HCBA? Make Sure Your Member Profile is Updated at hillsbar. com.
2 6 N O V- D E C 2 0 1 7 | H C B A L A W Y E R