Monday, September 19, 2011

FAKE DOCTOR PLEADS GUILTY TO HEALTH CARE FRAUD AND CRIMINAL HIPAA VIOLATIONS

FOR IMMEDIATE RELEASE
September 14, 2011
http://www.jusice.gov/usao/gan/

CONTACT: Patrick Crosby
(404)581-6016
FAX (404)581-6160

Matthew Paul Brown Impersonated a Doctor,
Treated Over 1,000 Patients, and Wrongfully Disclosed Their Health Information

ATLANTA, GA - MATTHEW PAUL BROWN, 30, formerly of Atlanta, Georgia and Nashville, Tennessee, pleaded guilty today in federal district court to charges of health care fraud and wrongful disclosure of individually identifiable health information.

United States Attorney Sally Quillian Yates said, “Medicare and Medicaid provide treatment for some of our community’s most vulnerable citizens: the elderly, young children and the financially needy. These vulnerable citizens deserve to be treated by medical personnel who have been duly trained and licensed and not by someone impersonating a doctor. This defendant’s crime defrauded over a thousand people of the care they deserved and defrauded Medicare, Medicaid and private health insurance companies of funds intended and needed for legitimate health care.”

Brian D. Lamkin, Special Agent in Charge, FBI Atlanta Field Office, said: “The reckless conduct displayed by the defendant not only displayed a total disregard for the patients that he was improperly and illegally treating but also for those individuals who could have legitimately benefitted from the federal medicaid/medicare funds. The FBI works hard to ensure that these healthcare based federal funds are used as intended and dedicates substantial investigative resources to bringing such activities as Mr. Brown's to justice.”

According to United States Attorney Yates and the charges: From November 2009 through April 5, 2011, BROWN carried out a health care fraud scheme in the metro Atlanta and Nashville, Tennessee areas. While operating in the Atlanta area, from November 2009 through August 2010, BROWN approached numerous practicing physicians and persuaded them to bill Medicare, Medicaid, and private health insurers under their own provider numbers for allergy-related care provided by BROWN. The care was provided both at the physicians’ own offices and at health fairs, with the physicians agreeing to pay BROWN between fifty and eight-five percent of a total of approximately $1.2 million they received from the health care benefit programs. BROWN has never been licensed in Georgia as a physician, physician assistant, nurse practitioner, or clinical nurse specialist.

The United States is not aware of any patients who were seriously injured by care received from BROWN. BROWN purchased the needles and allergy shots he used from a commercial pharmacy. The United States is not aware of any evidence that BROWN ever used unsterile needles for the shots. The U.S. Attorney’s Office has notified the individuals treated by BROWN, to the extent it was possible to identify and locate them.

BROWN also pleaded guilty to wrongful disclosure of individually identifiable health information, in violation of the Health Insurance Portability and Accountability Act (“HIPAA”). The individually identifiable health information wrongfully disclosed by BROWN was a spreadsheet he created with information concerning each person he treated. BROWN sent the spreadsheet to an undercover FBI agent, who BROWN believed to be an investor considering a large investment in BROWN’s business.

BROWN was indicted in April 2011. He pleaded guilty to the indictment today. The indictment charges 17 counts of health care fraud, each of which carries a maximum sentence of 10 years in prison and a fine of up to $250,000. The HIPAA charge also carries a maximum sentence of 10 years in prison and a fine of up to $250,000. In determining the actual sentence, the Court will consider the United States Sentencing Guidelines, which are not binding, but provide appropriate sentencing ranges for most offenders.

Sentencing for BROWN is scheduled for November 22, 2011, at 11 a.m., before United States District Judge Amy Totenberg.

This case is being investigated by Special Agents of the Federal Bureau of Investigation. Assistance has been provided by the City of Duluth Police Department.

Assistant United States Attorney Alana R. Black is prosecuting the case.

For further information please contact Sally Q. Yates, United States Attorney, or Charysse L. Alexander, Executive Assistant United States Attorney, through Patrick Crosby, Public Affairs Officer, U.S. Attorney's Office, at (404) 581-6016. The Internet address for the HomePage for the U.S. Attorney's Office for the Northern District of Georgia is www.justice.gov/usao/gan.

Tuesday, February 22, 2011

HHS imposes a $4.3 million civil money penalty for violations of the HIPAA Privacy Rule

HHS imposes a $4.3 million civil money penalty for violations of the HIPAA Privacy Rule
Action marks first civil money penalty issued by HHS for HIPAA Privacy Rule violations
The U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) has issued a Notice of Final Determination finding that Cignet Health of Prince George’s County, Md., (Cignet) violated the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HHS has imposed a civil money penalty (CMP) of $4.3 million for the violations, representing the first CMP issued by the Department for a covered entity’s violations of the HIPAA Privacy Rule.
The CMP is based on the violation categories and increased penalty amounts authorized by Section 13410(d) of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
“Ensuring that Americans’ health information privacy is protected is vital to our health care system and a priority of this Administration. The U.S. Department of Health and Human Services is serious about enforcing individual rights guaranteed by the HIPAA Privacy Rule,” said HHS Secretary Kathleen Sebelius.
In a Notice of Proposed Determination issued Oct. 20, 2010, OCR found that Cignet violated 41 patients’ rights by denying them access to their medical records when requested between September 2008 and October 2009. These patients individually filed complaints with OCR, initiating investigations of each complaint. The HIPAA Privacy Rule requires that a covered entity provide a patient with a copy of their medical records within 30 (and no later than 60) days of the patient’s request. The CMP for these violations is $1.3 million.
During the investigations, Cignet refused to respond to OCR’s demands to produce the records. Additionally, Cignet failed to cooperate with OCR’s investigations of the complaints and produce the records in response to OCR’s subpoena. OCR filed a petition to enforce its subpoena in United States District Court and obtained a default judgment against Cignet on March 30, 2010. On April 7, 2010, Cignet produced the medical records to OCR, but otherwise made no efforts to resolve the complaints through informal means.
OCR also found that Cignet failed to cooperate with OCR’s investigations on a continuing daily basis from March 17, 2009, to April 7, 2010, and that the failure to cooperate was due to Cignet’s willful neglect to comply with the Privacy Rule. Covered entities are required under law to cooperate with the Department’s investigations. The CMP for these violations is $3 million.
“Covered entities and business associates must uphold their responsibility to provide patients with access to their medical records, and adhere closely to all of HIPAA’s requirements,” said OCR Director Georgina Verdugo. “The U.S. Department of Health and Human Services will continue to investigate and take action against those organizations that knowingly disregard their obligations under these rules.”
Individuals who believe that a covered entity has violated their (or someone else’s) health information privacy rights or committed another violation of the HIPAA Privacy or Security Rule may file a complaint with OCR athttp://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html.
Notice of Final Determination of HIPPA Violations of Cignet

What is Single Payer

What is Single Payer?

Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system. (Just imagine how complex billing must be in a doctor’s office, when each insurance company requires a different form to be completed, has a different billing system, different billing contacts and phone numbers—it’s very confusing.) In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.

What is Single Audit?

Each year, the Federal Government provides over $400 billion in grants to State, local and tribal governments, colleges, universities and other non-profit organizations (non-Federal entities). The Single Audit Act of 1984 (with amendment in 1996) and OMB Circular A-133 ("Audits of State, Local Governments, and Non-Profit Organizations") provide audit requirements for ensuring that these funds are expended properly. All non-Federal entities that expend $500,000 or more of Federal awards in a year ($300,000 for fiscal year ending on or before December 30, 2003) are required to obtain an annual audit in accordance with the Single Audit Act Amendments of 1996 (pdf), OMB Circular A-133, the OMB Circular Compliance Supplement and Government Auditing Standards. A single audit is intended to provide a cost-effective audit for non-Federal entities in that one audit is conducted in lieu of multiple audits of individual programs. The Single Audit provides the Federal government with assurance that these recipients comply with such directives by having anindependent external source (the CPA) report on such compliance.

OMB Circular A-133 Compliance Supplement 2009