Oh what a tangled web of Medicare fraud…

Yesterday, I linked to an article in Dallas Morning News about a former Parkland Memorial Hospital employee who will plead guilty to misusing patient information for a Medicare fraud scheme.  That breach had previously been reported on this blog in 2011.

The problem with the type of Medicare fraud involving home health care services he engaged in is rampant throughout North Texas, it seems. As Kevin Krause also reported:

Since 2012, federal investigators have brought charges against several area doctors and nurses, alleging they billed Medicare for more than $475 million in fraudulent claims. At least 800 home health care agencies in North Texas are accused of participating in the schemes. Many others are under investigation.

How many people have have become victims of medical identity theft for these schemes? The numbers could be staggering.

In any event, Viju Mathew used the patient information he had access to at Parkland to get referrals for Dallas Home Health Care, a company he formed in 2006. Mathew’s wife, Mariamma Viju, a Baylor Hospital nurse and part-owner of Dallas Home Health Care, also allegedly stole patient information from her hospital to recruit patients for their business.  She has not been charged (yet?), and I don’t see any entry on HHS’s public breach tool that might correspond to this alleged data theft.

The scope of these schemes seems quite extensive, though. As Krause also reports:

Witnesses told agents that Mathew’s brother-in-law, Mathew V. Chacko, also took part in the scheme. He has not been charged. Chacko, 42, a Dallas Home Health Care administrator, worked as a nurse at Mesquite Specialty Hospital, records show. Federal authorities said he “marketed directly to his patients” at the hospital.

For their part, the patients don’t all seem totally innocent, as many seemingly accepted inducements for the health care agency to misuse their information:

Mathew gave the patients cash, food and grocery gift cards to get them to stay on as clients, court records show. Authorities say he misused the private information of more than 3,000 patients.

Mathew’s wife allegedly falsified notes and diagnoses to keep the patients as clients.

So other than the taxpayers, who are the victims here? I continue to have a tough time seeing cooperating patients as victims of medical identity theft in these schemes.

 

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