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Recent HIPAA Violations, Medicare Fraud and Healthcare Kickback Cases

I wanted to provide weekly summaries of recent cases of concern to the Healthcare Provider. These actual cases and lawsuits can provide valuable guidance to the healthcare provider and assist their staff in creating policies and staff training to avoid these type of compliance issues.  Our company defends these type of audit cases daily.

If you have any compliance concerns, reach out to me at [email protected] for assistance.

Tuesday, December 12, 2023

Party Punished: Manasa Health Center, LLC
Location:              Kendall Park, NJ
Issue:                    HIPAA

Summary:           In April 2020, Manasa Health Center impermissibly disclosed the protected health information of a patient when the entity posted a response to the patient’s negative online review. Following an OCR investigation, potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule include impermissible disclosures of patient protected health information in response to negative online reviews, and failure to implement policies and procedures with respect to protected health information.

Resolution:         Manasa Health Center paid $30,000 to OCR and agreed to implement a corrective action plan.


Party Punished: Kristin Marie Stiggleman
Location:              Hillsborough County, FL
Issue:                    Medicare Fraud

Summary:           Attorney General Ashley Moody’s Medicaid Fraud Control Unit is announcing the arrest of a speech-language pathologist for defrauding Florida Medicaid. Kristin Marie Stiggleman, a therapy provider in Hillsborough County, inflated hours by billing for services not provided and misappropriating more than $5,000 from the taxpayer-funded program. The Hillsborough County Sheriff’s Office assisted in arresting Stiggleman who is charged with Medicaid provider fraud and grand theft.
Resolution:         Stiggleman faces one count of Medicaid-provider fraud and one count of grand theft, both third-degree felonies. Assistant Attorney General Joseph Kelly, through the Attorney General’s Office of Statewide Prosecution, will prosecute the case.



Party Punished: Innovative Sleep Centers PLLC
Location:              Seattle, WA
Issue:                    Medicare Fraud

Summary:           Between 2013 and 2022, Innovative Sleep Centers (ISC) submitted three categories of false claims for payment to Medicare and Medicaid.

Between January 2018 and December 2020, ISC submitted false claims to Medicare for evaluation and management (E&M) services that were performed by lower-level providers, but billed under the name of ISC’s Medical Director, Dr. Mehrdad Razavi. By identifying a physician as the rendering provider on the claims, the clinic was able to bill at a higher rate. Those bills were false.
Between October 2013 and July 2022, ISC submitted claims to Medicare for office visits that falsely identified Dr. Razavi as the rendering provider. In fact, the services were provided by employees who were not qualified to perform office visits, including office staff, Respiratory Therapists, and Registered Polysomnographic Technologists. By billing the claims under a physician’s NPI, ISC obtained reimbursement for non-covered services.
And finally, between January 2015 and December 2020, ISC submitted false claims to Medicare and Medicaid for sleep studies that were performed by technologists who did not have required credentials.         Codefendant Christopher Patrick Cruz, 49, of San Antonio, is scheduled to be sentenced Nov. 21. Cruz owned a medical marketing business and conspired with Price to increase the volumes of prescriptions of specific pharmacies.

Resolution:         The clinics paid $644,562 to resolve the matter.


Party Punished: Daphne Jenkins/Nurse Practitioner
Location:              Boston, MA
Issue:                    Health Fraud/Kickbacks

Summary:           Between December 2018 and April 2020, Jenkins worked with a telemedicine company to sign orders for medically unnecessary durable medical equipment. These orders signed by Jenkins were pre-populated based on telemarketing calls made to Medicare beneficiaries, that Jenkins never had any contact with the beneficiaries herself and had no medical relationship with the beneficiaries, and that she generally signed these orders without even reading them. Once Jenkins signed these orders, the telemarketing company sold the orders to DME suppliers and laboratories, which then submitted claims to Medicare. As a result of Jenkins’ participation in this conspiracy, over $7.8 million in claims were submitted to Medicare for DME that was medically unnecessary, based on false documentation, and tainted by kickbacks.

Resolution:          Sentencing scheduled for April 10, 2024.

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