From: drarwingnuttephd@gmail.com   
      
   Warning to Executives: More Executives Could Face Fraud Charges - Feds Ramp Up   
   Healthcare Fraud-Fighting Efforts    
      
      
      
      
      
      
      
      
   More Executives Could Face Fraud Charges    
   Feds Ramp Up Healthcare Fraud-Fighting Efforts    
      
   By Marianne Kolbasuk McGee, October 8, 2014. Follow Marianne @HealthInfoSec    
      
      
      
   HHS OIG's 'most wanted' fugitive, Etienne Allonce    
   Federal authorities are ramping up efforts to crack down on healthcare fraud,   
   announcing plans to prosecute top executives at hospitals and other   
   organizations involved with fraud - and target other fraudsters as well.    
      
   2014 Fraud Summit - a must have resource for all of your fraud education.   
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   Leslie Caldwell, assistant attorney general for the criminal division at the   
   Department of Justice, said in a recent presentation: "We are stepping up our   
   prosecutions of corporations involved in healthcare fraud. Corporate   
   healthcare fraud cases are a    
   natural fit for us in light of our healthcare fraud expertise and our   
   prosecutions of corporate cases in the financial fraud and foreign bribery   
   arenas. We have numerous ongoing corporate healthcare fraud investigations,   
   and we are determined to bring    
   more."    
      
   Warning to Executives    
      
      
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   Healthcare attorney Peter Zeindenberg, a partner in the Washington officer of   
   the law firm Arent Fox, says that the Justice Department's warning is aimed at   
   top executives at hospitals and other healthcare organizations where   
   fraudulent activities,    
   ranging from false Medicare billing to illegal kick-backs, are taking place.    
      
   For the most part, fraud-related cases against healthcare organizations have   
   often ended up with restitution or settlements, not criminal prosecutions of   
   executives that involve prison time, he says. "Companies have been able to   
   resolve these cases by    
   entering into non-prosecution or deferred prosecution agreements and leave   
   individual executives untouched," he says. In large part due to public   
   pushback on corporate executives too often getting passes, the Justice   
   Department is sending out signals    
   that it "wants to serve up executives on a silver platter," for misconduct   
   that includes healthcare fraud, Zeidenberg says. But the attorney says he's   
   "somewhat dubious" that will actually happen.    
      
   OIG Crack Down    
   In addition to the Justice Department's efforts, the Department of Health and   
   Human Services' Office of Inspector General is also stepping up its fraud   
   crackdown activities. OIG often gets involved in criminal cases against owners   
   of small medical    
   companies or clinics - or individual physicians - where false billing and   
   identity fraud is alleged, says Scott Lampert, assistant special agent in   
   charge of the HHS OIG's New York Regional Office, Office of Investigations.    
      
   "Cases involving identity theft are a growing problem," he tells Information   
   Security Media Group. "Medical ID numbers are an ATM card to fraudsters."    
      
   One of the largest "and most blatant" such cases to date was the prosecution   
   and conviction of the owner of a Long Island, N.Y., medical supply company who   
   posed as a clinician when visiting nursing homes. Helene Michel entered   
   nursing homes pretending    
   she was a clinician and stole information from patient charts, submitting more   
   than $7 million in fraudulent Medicare billing using those records, Lampert   
   says (see Hefty Prison Sentence In ID Theft Case).    
      
   In April 2013, Michel was convicted on charges of healthcare fraud and   
   wrongful disclosure of individually identifiable health information. She was   
   sentenced to 12 years federal prison time and ordered to pay more than $4.4   
   million in restitution.    
      
   Her husband and co-conspirator, Etienne Allonce, for the second year in a row   
   tops the HHS OIG's "most wanted" fugitive list. Joseph Giambalvo, special   
   agent with the HHS OIG's New York regional office, tells ISMG that Allonce is   
   believed to be in Haiti.    
   "We have an arrest warrant out for him," he says.    
      
   The fraud case involving Allonce and Michel "is one of the largest medical   
   identity theft cases we've had, and the first prosecution in the Northeast of   
   a HIPAA case for the misuse of personal health information for profit,"   
   Lampert says.    
      
   In that case, Michel allegedly stole patient information from paper charts.   
   But even with the growing use of electronic health records in healthcare   
   facilities, many healthcare providers, including nursing homes, still rely on   
   paper records, Giambalvo    
   says. "There's generally growing awareness at nursing homes that these medical   
   charts and [patient] face sheets have been one-stop shopping for ID thieves,"   
   although unsecured digitized records are also a risk, he adds.    
      
   Many healthcare fraud cases involving medical ID theft involve the   
   perpetrators violating HIPAA by unlawfully using patient's personally   
   identifiable health information, Zeidenberg says. However, HIPAA violations   
   are typically not the focus of those    
   criminal cases.    
      
   Strike Force    
   OIG, DOJ and the FBI, along with state and local law enforcement, have also   
   been ramping up collaborative efforts to fight Medicare fraud including   
   through a Strike Force program, launched in 2007, that focuses on nine   
   geographic "hot spots" for fraud.    
   Strike Force teams harness data analytics to identify and combat Medicare   
   fraud, waste and abuse, an OIG spokespeson says.    
      
   One of the largest Strike Force busts to date was in May, when federal charges   
   were filed against 90 individuals in six states who prosecutors say are   
   allegedly tied to Medicare fraud schemes responsible for $260 million worth of   
   false billings (see 90    
   Charged In Medicare Fraud Schemes).    
      
   A Justice Department spokesman declined ISMG's request for comment on the   
   department's healthcare fraud enforcement activities.    
      
   Follow Marianne Kolbasuk McGee on Twitter: @HealthInfoSec    
      
      
   http://www.govinfosecurity.com/more-executives-could-face-fraud-   
   harges-a-7409/op-1   
      
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