By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
What is a “compromised physician” or “compromised health provider”? It may not be what you think it is.
This term is used from time to time to refer to health professionals, physicians and health facilities whose identities and billing numbers have been stolen and crooks are utilizing them to falsely bill Medicaid, Medicare, Tricare and health care insurance programs for services that were never performed.
Stolen Medical Identities
Every now and then, these “compromised healthcare providers” have their identifying information ordered into lists which are sold or exchanged from one criminal to the next. This may wind up causing thousands of false claims to be submitted using their identification. This could cause millions of dollars in taxpayer money or in health insurance proceeds to be paid out to thieves.
The Centers for Medicare and Medicaid Services (CMS) maintains a list of compromised providers that is used to screen for any claim submitted under that providers identification, including prescriptions, orders for durable medical equipment, orders for home health services, orders for diagnostic tests and other services paid by a third party payer. CMS estimates that there are approximately 5,000 providers whose medical identities have been stolen and used to submit false claims. A physician may be on this list and not even know it until his or her claims start being denied.
In 2011, Cybil G. Roehrenbeck of the American Medical Association wrote a good article explaining the entire problem in detail. I highly recommend that you review it and you can do so by clicking here.
CMS has published a “Fraud, Waste and Abuse Toolkit” to help physicians and other health care providers prevent the false use of their billing information. It is titled: “Health Care Fraud and Program Integrity: An Overview for Providers.” It also has several other informational publications on how physicians and other health professionals can avoid identity theft. You can access these publications by clicking here:
Contact Experienced Health Law Attorneys.
The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the DEA, Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Roehrenbeck, Cybil. “Physician Identity Theft.” ABA Health eSource. (October 2011). Web.
“Fraud, Waste, and Abuse Toolkit.” Centers For Medicare and Medicaid Services.(July 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.
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