2/4/2015 1 Medical Identity Theft Robin Bonn Special Agent Office of Inspector General/ Office of Investigations U.S. Department of Health and Human Services Portland, Oregon LIMITED OFFICIAL USE ONLY DHHS/OIG Learning Objectives • Understand the mission of HHS/OIG • Recognize the different types of medical identity theft 2/4/2015 LIMITED OFFICIAL USE ONLY DHHS/OIG 2 HHS Office of Inspector General: Background • Mission: Protect the integrity HHS programs as well as the health and welfare of program beneficiaries • Fight fraud, waste, abuse in Medicare & Medicaid, plus 300 other HHS programs • Largest Inspector General’s office in Federal Government • Office of Investigations performs criminal, civil and administrative enforcement 2/4/2015 LIMITED OFFICIAL USE ONLY DHHS/OIG 3
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2/4/2015
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Medical Identity Theft
Robin BonnSpecial Agent
Office of Inspector General/ Office of InvestigationsU.S. Department of Health and Human Services
Portland, Oregon
LIMITED OFFICIAL USE ONLY DHHS/OIG
Learning Objectives
• Understand the mission of HHS/OIG
• Recognize the different types of medical identity theft
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HHS Office of Inspector General: Background
• Mission: Protect the integrity HHS programs as well as the health and welfare of program beneficiaries
• Fight fraud, waste, abuse in Medicare & Medicaid, plus 300 other HHS programs
• Largest Inspector General’s office in Federal Government
• Office of Investigations performs criminal, civil and administrative enforcement
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HHS/OIG: Components
• Office of Evaluations & Inspections: – Conducts and publishes studies on various vulnerabilities in Medicare/Medicaid.
Reports on OIG website with recommendations. Several drug related reports.
• Office of Audit: – Conducts independent audits of HHS programs/grantees. Also create reports and
make recommendations.
• Office of Council to IG: – Provides legal counsel to IG and other components. Performs civil monetary
penalties, provider self disclosures, collaborates with DOJ on national cases.
• Office of Management and Policy: – Provides mission and administrative support to the OIG
• Office of Investigations: – Law enforcement arm of OIG, which uses both traditional law enforcement
techniques along with contemporary data analytic tools to identify trends and targets for investigations and prosecution
– Theft of Doctor’s information• Provider Identification Number (PIN) and Personally
Identifiable Information
– Theft of Beneficiary information• Health Insurance Claim Number’s
• Beneficiaries identity
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Medicare’s experience
• Medicare started seeing an uptick in provider identity theft in 2005. We learned a few things and put in place some safeguards that have helped and while it still occurs, it isn’t as widespread as it once was.
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History in Medicare
• Started around 2005 with “shell” labs. These were labs in name only, there was no equipment.
• Morphed into Physician ID Theft where the name of a real physician to establish a second PIN which was then used to bill for services.
• Current trend is to “recruit” physicians to help with the scheme.
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John and David Mkhitarian
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• The cousins used exchange students to create some 70 bogus laboratories, clinics and physician practices, then enrolled the companies in the Medicare program with the stolen identities.
• Medicare paid out $3.3 million over about two years.
• HHS-OIG and DSS investigated the case
John and David Mkhitarian
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• What’s the lesson here?
Health Insurance Claim Number Theft
• Another common problem is when health insurance claim numbers get compromised
• Identity thieves seek employment in medical facilities for sole purpose of ID theft – Temporary Employees or Employed for Short Duration
– Typically Receptionists/Medical Billers
– HIPPA violations in the disposal of records
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Case Example
• U.S. v Alyse Burrell and Horace Mitchell
• A Joint Investigation by Regence SIU, HHS-OIG Seattle Field office, and the FBI Seattle Division.
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Defendants
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March 2010 to January 2011
• Approximately 60 Patient’s Identities Utilized.
• Approximately 3 Doctor’s Identities Utilized.
• Approximately 50 Pharmacies Utilized throughout Washington State and Oregon.
• Targeted Medicare Advantage Plans and Medicaid to pay for the fraudulent prescriptions.
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Prescription Drugs Obtained
and Attempted to be Obtained
• Oxycodone - 145,930mg.
• Which equals approximately 4,864 – 30mg tablets.
• Current street value of 30 mg tablets is approximately $18.00 per tablet. Therefore the total street value of the Oxycodone tablets was approximately $87,552.
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Hydrocodone
• Hydrocodone – 4,569 tablets (10-325mg).
• Current street value of Vicodin tablets is approximately $7.00 per tablet. Therefore the total street value of the Hydrocodone tablets was approximately $31,983.
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Methadone
• Methadone - 1,550 tablets.
• Current street value of 10mg tablets is $5.00 per tablet. Therefore the total street value of the Methadone tablets was $7,750.
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Grand Totals
• Street value of Prescription Pills = $127,285
• Out of Pocket Co-Pay = $536.90
• Thanks Tax Paying Citizens!
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Arrested in Oregon
• Washington County Sheriff ’s Office arrests BURRELL and MITCHELL outside of a pharmacy in Oregon.
• BURRELL and MITCHELL rented a car to travel to OR. OR was targeted due to less stringent security features required on prescription paper.
• Both charged with state violations and released.
• Activity continued in Washington and again in Oregon.
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Federal Search Warrants
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Parent’s Residence - Seattle
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Destruction of Evidence
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Items Found During the Search Warrant Execution
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Prescription's Seized
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Additional Medicare Advantage Members Identification
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U.S. v Alyse Burrell and Horace Mitchell
• Strongest evidence in this case was against BURRELL.
• MITCHELL headed for trial and pled two weeks out after fingerprint was lifted from paper cutter and ATM video showed MITCHELL depositing cash into a dirty account.
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U.S. v Alyse Burrell and Horace Mitchell
• BURRELL pled guilty to 18 U.S.C. § 1028a Aggravated Identity Theft (predicate offense was Healthcare Fraud) and 21 U.S.C. § 841, 843 and 846 Conspiracy to Acquire Controlled Substances by Fraud and to Distribute Controlled Substances.
• Sentenced to 60 months.
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U.S. v Alyse Burrell and Horace Mitchell
• MITCHELL pled guilty to 18 U.S.C. § 1028a Aggravated Identity Theft (predicate offense was Healthcare Fraud) and 21 U.S.C. § 841, 843 and 846 Conspiracy to Acquire Controlled Substances by Fraud and to Distribute Controlled Substances.
• Sentenced to 54 months.
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• Washington beneficiaries getting prescriptions filled in Oregon pharmacies.
• Recruiters utilizing low income Medicare / Medicaid beneficiaries to present forged prescriptions and utilize prescription drug benefit to pay. Current investigations involve beneficiaries who have received as much as $500.00 per prescription.
• The most targeted drug is 30mg Oxycodone tablets.
• Current High Forgery Areas in WA are South King County and Northern Pierce County.
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• Use available databases to scrutinize scripts; including your state PDMP database
• If receive a clearly fraudulent script, forged script, ID theft; engage law enforcement immediately
• If you suspect a Medicare provider or beneficiary is diverting, contact – 800-HHS-TIPS or at
– oig.hhs.gov/report-fraud
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Joint case with Social Security OIG
• Davis Adder Edwards
– Stole the identity of his deceased uncle to carry out multiple fraud schemes.
– Applied for and received Social Security Disability under the stolen identity
– Received SSI Benefits
– Received Medicare benefits as a result of being on SSI.
– Worked under another identity.
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• Washington’s Most Wanted Video
Davis Adder Edwards
• Medicare (you the taxpayer) paid over $175,000 for Edwards’ medical care.