What is a Compromised Physician or Health Care Provider?

Monday, November 21, 2016
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Do you know what a "compromised physician" or "compromised health provider" is?  It may not be what you think it is.

This is a rarely seen term used to refer to physicians, health professionals and health facilities whose identities and billing numbers have been stolen and have been or are being used by crooks to falsely bill Medicare, Medicaid, Tricare and health insurance programs for services never rendered.


Stolen Medical Identities.

Sometimes these "compromised healthcare providers" are on lists and their identifying information is sold or traded from one criminal to another winding up with thousands of false claims being submitted using their identification.  

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:


Helpful Resources.

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 them here.


Contact Experienced Health Law Attorneys.

The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in  Centers for Medicare and Medicaid Services (CMS) investigations, Medicare Audit defense, 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.


Sources:

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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11/21/2016

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