Indictment Issued for False Statements to CMS and Aggravated Identity Theft
By Jim Tate, EMR Advocate
Meaningful Use Audit Expert
Twitter: @JimTate, eMail: audits@emradvocate.com
It was just a matter of time before the CMS EHR Incentive audit process uncovered alleged actions so severe that there was nothing left to do but issue Federal criminal indictments. I’ve been waiting for some time for the first report of this type of indictment. During the early years of the complex program it was obvious that “knowledge gaps” on the part of Eligible Professionals (EPs) and Eligible Hospitals (EHs) could easily lead to errors in meaningful use (MU) attestations. These errors would only turn up if an audit took place. Since so much of attestation is based on the “honor system” only a vigorous audit of pre- and post-payment attestations could shake the bad apples from the tree and separate the knowledge gaps from willful actions.
So what is this specific case all about? Well, let’s first state the obvious: “A grand jury indictment is not evidence of guilt, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.” For the details of the indictment we have the FBI to thank:
“Joe White, 66, of Cameron, Texas, was indicted by a federal grand jury on January 22, 2014, and charged with making false statements to the Centers for Medicare and Medicaid Services (CMS) and aggravated identity theft.”
“According to the indictment, on November 20, 2012, White falsely attested to CMS that Shelby Regional Medical Center (Shelby Regional) met the meaningful use requirements for the 2012 fiscal year. However, Shelby Regional relied on paper records throughout the fiscal year and only minimally used electronic health records. To give the false appearance that the hospital was actually using Certified Electronic Health Record Technology, White directed its software vendor and hospital employees to manually input data from paper records into the electronic health record (EHR) software, often months after the patient was discharged and after the end of the fiscal year.”
“The indictment further alleges that White falsely attested to the hospital’s meaningful use by using another person’s name and information without that individual’s consent or authorization. As a result of the false attestation, CMS paid Shelby Regional $785,655. In total, hospitals operated by Dr. Mahmood, including Shelby Regional, were paid $16,794,462.66 by the Medicaid and Medicare EHR incentive programs for fiscal years 2011 and 2012.”
“If convicted, White faces up to five years in federal prison for making a false statement and up to two years in federal prison for aggravated identity theft.”
I don’t have too much else to say about this incident, but I will close with a quote from Special Agent in Charge, Mike Fields. “As more and more federal dollars are made available to providers to adopt Electronic Health Record systems, our office is expecting to see more cases like this one”. I’m guessing the moral of this story comes from the Scriptures of old: “He who has ears, let him hear”.
Jim Tate is known as the most experienced authority on the CMS Meaningful Use (MU) audit and appeal process. His unique combination of skills has brought successful outcomes to hospitals at risk of having their CMS EHR incentives recouped. He led the first appeal challenge in the nation for a client hospital that had received a negative audit determination. That appeal was decided in favor of the hospital. He has also been successful in leading the effort to reverse a failed appeal, even after the hospital had received notification of the failure with the statement, “This decision is final and not subject to further appeal”. That “final” decision was reversed in less than a week. If you are a hospital with questions or concerns about the meaningful use audit process, contact him at: audits@emradvocate.com. This post was originally published in MeaningfulUseAudits.com.