August 21, 2012

Supply Company Owner Prosecuted for Criminal HIPAA Violation

By

alert-powered-by-decision-health

A four-and-a-half-year, $10.7 million scheme resulted in the conviction of a Long Island, N.Y., medical supply company owner on charges of Medicare fraud and wrongful disclosure of private patient information.

The criminal conviction is one of the first for wrongful disclosure of patient information under HIPAA, according to the U.S. Attorney’s Office in eastern New York.

Helene Michel, who also used the alias Dr. Elene Allonce, stole patient information from Long Island nursing homes then submitted thousands of fraudulent claims to Medicare, according to the U.S. Attorney’s Office in eastern New York. Among the claims presented at trial was “the defendant’s demand for reimbursement for supplying boots and braces to an elderly patient who was, in fact, an above-the-knee double amputee,” the U.S. Attorney’s Office noted.

She faces up to 10 years in prison and fines of up to $250,000 per count, the U.S. Attorney’s Office noted.

For more on the case, visit http://www.justice.gov/usao/nye/pr/2012/2012aug15.html.

In other fraud news, the owner of a Miami home health agency pleaded guilty in connection with a $60 million kickback scheme.

Rodolfo Nieto Jr. owned Ronat Home Health Care Inc. and from January 2006 to November 2009, recruited Medicare patients for Nany Home Health Inc. and received kickbacks, according to the Justice Department. Three other people were sentenced to prison time after pleading guilty in relation to the case. Nieto faces up to five years in prison and a $250,000 fine or twice the gain or loss.

Two RACs post issues

In recovery auditor (RAC) news, Connolly – the RAC for Region C – and HealthDataInsights – the RAC for Region D – posted a total of 14 issues this week for DME suppliers, inpatient rehabilitation facilities, outpatient hospitals, physicians and other carriers/billers. For more details, see the chart below.

CLICK TO DOWNLOAD RAC ISSUES

About the Author

Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

Contact the Author

KLong@decisionhealth.com

To comment on this article please go to editor@racmonitor.com

Taking Care of Business with Clinical Documentation Improvement

Karen Long

This email address is being protected from spambots. You need JavaScript enabled to view it.