Helene Michel, out of Hicksville, NY the owner of Medical Solutions Management Inc., medical supply company, according to PHIPrivacy.net, was convicted of $10.7 million Medicare fraud and wrongful disclosure of private patient information in September. Michel was sentenced to 12 years in federal prison by United States District Judge Joseph F. Bianco (Ouellette, 2013). She used her position at MSM to steal patient data over a four-and-a-half-year period from April 2003 to March 2007, from Long Island nursing homes (Nassau, Suffolk, Queens, Kings, and Dutchess Counties). Michel then used that information to submit fake Medicare claims that never covered any of her patients. One example of fraud was when she used a false claim to get reimbursed for a double amputee’s boots to fund a $2.2 million home and new pension for herself. Michel used false aliases such as “Dr. Elene Allonce” and faced a maximum sentence of 10 years’ imprisonment on each count and $250,000 fines per count. (Ouellette, 2013).
It is a violation of the Health Insurance Portability and Accountability Act (“HIPAA”). During the scheme, Michel also falsely assumed a number of roles, including posing at various times as a doctor, a nurse practitioner, and a wound care expert. At times, in her false roles, Michel even joined doctors on patient evaluation rounds. Thereafter, Michel used the records that she stole to create and submit $10 million in false billings to Medicare for medical supplies and products that were either not needed or delivered. Michel submitted false claims for the purchase of expensive wound care bandages to treat patients who never had such wounds. In the event that Medicare denied an MSM claim, Michel submitted an appeal of the denial supported by additional stolen and altered patient records. (“Long Island Health Care,” 2013). In reality, Michel was a con woman, deceiving patients and administrators alike as she stole what is supposed to be private patient information and submitted fraudulent claims to Medicare to support her extravagant lifestyle. Michel’s lavish lifestyle ended up costing her time in prison.
At the sentencing, Judge Bianco also ordered that Michel forfeit $1.3 million that was seized by the government at the time of her indictment. Through her scheme she violated the privacy of over a thousand patients and stole Medicare funds dedicated to preserving the health of our seniors and other citizens. We, and our law enforcement partners, will vigorously pursue and prosecute those who seek to profit by such despicable crimes,” said Lynch. (Absetz, 2013). This could have all been prevented had better security measures been put into place. Even though she was the owner there still should have been auditing and evaluation of the medicare claims that she was filing. Her identity was also another factor. There needs to be more security cautions put into place as well to verify who is claiming they are a doctor or any other healthcare professional. This is a lack of security verifications and auditing. This case really blew my mind. The patients that were affected have to be incomplete disbelief. They are probably not going to trust healthcare professionals too much after this incident.
Absetz, E. (2013, April 12). LI Woman Sentenced to 12 Years for $10 Million Medicare and HIPAA Identity Theft Scam. Retrieved from http://seclists.org/dataloss/2013/q2/30
Long Island Health Care Provider Sentenced to 12 Years in Prison for $10 Million Medicare Fraud and Hipaa Identity Theft.(2013, April 10). Retrieved from http://www.justice.gov/usao/nye/pr/2013/2013apr10.html
Ouellette, P. (2013, April 11). NY patient identity thief sentenced for HIPAA violations. Retrieved from http://healthitsecurity.com/2013/04/11/ny-patient-identity-thief-sentenced-for-hipaa-violations/