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