Improper Release of PHI Draws Criminal Indictment

A physician in Virginia has been criminally indicted and charged with three counts of violating HIPAA in connection with release of protected health information ("PHI") to a patient's employer.  This criminal charge is unique in that it does not allege that the physician released the PHI for personal gain.  Instead, the charges are based on the fact that improper release was made "under the false pretenses that the disclosure of said information was necessary . . . . "  Specifically, the physician knew that the patient was not a serious and imminent threat to the safety of the public, but used that as a basis upon which to release the PHI to the patient's employer.

This indictment demonstrates that the government will pursue criminal charges if it disagrees with a health care provider's rationale for releasing PHI.  Health care providers should continue to carefully adhere to their HIPAA privacy policies when releasing any PHI, and consult with legal counsel in the event that they are unsure whether a release of PHI is permitted under HIPAA.       

OCR Strikes Again: Mass General Pays $1 Million to Settle HIPAA Violations

On the heels of the Cignet Health civil monetary penalty for $4.3 million only two days ago, the OCR has announced today that Mass General, one of the country's oldest and largest hospitals, has agreed to pay HHS $1 million to settle potential HIPAA violations.  The incident leading to this settlement involved an employee who brought documents on the subway with her, as she intended to work on them at home.  Unfortunately for Mass General, those documents contained PHI of 192 individuals and the employee accidentallty left the documents on the subway.  In addition to the million dollar payment, Mass General also agreed to enter into a Corrective Action Plan, which requires the hospital to develop additional privacy policies and procedures, ensure that employees complete additional HIPAA training, and provide HHS with semi-annual reports for the next three years.  The settlement agreement and Corrective Action Plan are available here.

OIG Unveils Most Wanted List

Showing a continued resolve to combat health care fraud and abuse, the Office of Inspector General (OIG) has launched a Most Wanted Fugitives List.  In an effort to engage the public in fighting health care fraud and abuse, the list identifies more than 170 individuals alleged to have committed health care fraud-related crimes.  According to the OIG's press release, the top ten individuals on this list have cost taxpayers over $124 million.  This announcement comes on the heels of the January 24, 2011 joint announcement by the U.S. Departments of Justice and Health and Human Services that the federal government recovered more than $4 billion taxpayer dollars in fiscal year 2010 from it's health care fraud prevention and enforcement efforts.  If the OIG's plan works and the public pitches in on the enforcement front as a result of the Most Wanted Fugitives List, 2011 could be another very busy year for the federal government's health care fraud and abuse team.




73 Charged in Nationwide Medicare Fraud Scheme

Federal prosecutors around the country have filed charges against 73 people alleging a nationwide Medicare fraud scheme that defrauded the government out of more than $35 million.  The U.S. Attorney in Manhattan has called this scheme the "single largest Medicare fraud ever perpetrated by a single criminal enterprise."  Over the last four years, this group of Armenian-Americans used stolen identities of real doctors and patients to bill Medicare for over $100 million for goods and services that were never provided and completely fabricated.  This health care fraud bust is only the latest in the government's efforts to combat abuse in federal program reimbursement.  Given the new enforcement mechanisms and funding under this year's health care reform, we are likely to see the government continue to increase its efforts to take down fraudulent health care billing schemes.

For more on these indictments, see the New York Times article and the Washington Post article on the story.