medical identity theft - hcca-info.org · • recognize the different types of medical identity...

2/4/2015

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Medical Identity Theft

Robin BonnSpecial Agent

Office of Inspector General/ Office of InvestigationsU.S. Department of Health and Human Services

Portland, Oregon

LIMITED OFFICIAL USE ONLY DHHS/OIG

Learning Objectives

• Understand the mission of HHS/OIG

• Recognize the different types of medical identity theft

2/4/2015 LIMITED OFFICIAL USE ONLY DHHS/OIG

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HHS Office of Inspector General: Background

• Mission: Protect the integrity HHS programs as well as the health and welfare of program beneficiaries

• Fight fraud, waste, abuse in Medicare & Medicaid, plus 300 other HHS programs

• Largest Inspector General’s office in Federal Government

• Office of Investigations performs criminal, civil and administrative enforcement


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HHS/OIG: Components

• Office of Evaluations & Inspections: – Conducts and publishes studies on various vulnerabilities in Medicare/Medicaid.

Reports on OIG website with recommendations. Several drug related reports.

• Office of Audit: – Conducts independent audits of HHS programs/grantees. Also create reports and

make recommendations.

• Office of Council to IG: – Provides legal counsel to IG and other components. Performs civil monetary

penalties, provider self disclosures, collaborates with DOJ on national cases.

• Office of Management and Policy: – Provides mission and administrative support to the OIG

• Office of Investigations: – Law enforcement arm of OIG, which uses both traditional law enforcement

techniques along with contemporary data analytic tools to identify trends and targets for investigations and prosecution


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OIG Statistics


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OIG Action FY10 FY11 FY12 FY13 FY14 Total

Criminal Actions 647 723 778 960 971 4,079

Civil Actions 378 382 367 472 533 2,132

Exclusions 3,340 2,662 3,131 3,214 4,017 16,364

HHS Investigative Receivables $3.2 Billion $3.6 Billion $4.3 Billion $4.0 Billion 2.9 Billion $ 18.2 Billion

Non-HHS Investigative Receivables $576.9 Million$952.8 Million

$1.7 Billion $1.02 Billion 1.1 Billion $5.3 Billion

Total Investigative Receivables $3.8 Billion $4.6 Billion $6.0 Billion $5.0 Billion 4.1 Billion $ 23.6 Billion

Where OIG Gets Cases


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• Industry – YOU!

• Hotlines – 1-800-HHS-TIPS

• Law Enforcement Partners

• Senior Medicare Patrol

• Data Analytics

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Types of Medical Identity Theft

• Medical Identity Theft Scheme

– Theft of Doctor’s information• Provider Identification Number (PIN) and Personally

Identifiable Information

– Theft of Beneficiary information• Health Insurance Claim Number’s

• Beneficiaries identity


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Medicare’s experience

• Medicare started seeing an uptick in provider identity theft in 2005. We learned a few things and put in place some safeguards that have helped and while it still occurs, it isn’t as widespread as it once was.


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History in Medicare

• Started around 2005 with “shell” labs. These were labs in name only, there was no equipment.

• Morphed into Physician ID Theft where the name of a real physician to establish a second PIN which was then used to bill for services.

• Current trend is to “recruit” physicians to help with the scheme.


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John and David Mkhitarian


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• The cousins used exchange students to create some 70 bogus laboratories, clinics and physician practices, then enrolled the companies in the Medicare program with the stolen identities.

• Medicare paid out $3.3 million over about two years.

• HHS-OIG and DSS investigated the case

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John and David Mkhitarian


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• What’s the lesson here?

Health Insurance Claim Number Theft

• Another common problem is when health insurance claim numbers get compromised

• Identity thieves seek employment in medical facilities for sole purpose of ID theft – Temporary Employees or Employed for Short Duration

– Typically Receptionists/Medical Billers

– HIPPA violations in the disposal of records


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Case Example

• U.S. v Alyse Burrell and Horace Mitchell

• A Joint Investigation by Regence SIU, HHS-OIG Seattle Field office, and the FBI Seattle Division.


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Defendants


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March 2010 to January 2011

• Approximately 60 Patient’s Identities Utilized.

• Approximately 3 Doctor’s Identities Utilized.

• Approximately 50 Pharmacies Utilized throughout Washington State and Oregon.

• Targeted Medicare Advantage Plans and Medicaid to pay for the fraudulent prescriptions.


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Prescription Drugs Obtained

and Attempted to be Obtained

• Oxycodone - 145,930mg.

• Which equals approximately 4,864 – 30mg tablets.

• Current street value of 30 mg tablets is approximately $18.00 per tablet. Therefore the total street value of the Oxycodone tablets was approximately $87,552.


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Hydrocodone

• Hydrocodone – 4,569 tablets (10-325mg).

• Current street value of Vicodin tablets is approximately $7.00 per tablet. Therefore the total street value of the Hydrocodone tablets was approximately $31,983.


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Methadone

• Methadone - 1,550 tablets.

• Current street value of 10mg tablets is $5.00 per tablet. Therefore the total street value of the Methadone tablets was $7,750.


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Grand Totals

• Street value of Prescription Pills = $127,285

• Out of Pocket Co-Pay = $536.90

• Thanks Tax Paying Citizens!


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Arrested in Oregon

• Washington County Sheriff ’s Office arrests BURRELL and MITCHELL outside of a pharmacy in Oregon.

• BURRELL and MITCHELL rented a car to travel to OR. OR was targeted due to less stringent security features required on prescription paper.


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Search of Rental Car


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Forged Prescriptions


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Other Items Seized

• Oxycodone and Hydrocodone tablets

• Loaded Firearm

• Laptop computer containing prescription templates and (doctor / patient information)

• Paper cutter


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Criminal Activity Continues

• Both charged with state violations and released.

• Activity continued in Washington and again in Oregon.


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Federal Search Warrants


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Parent’s Residence - Seattle


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Destruction of Evidence


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Items Found During the Search Warrant Execution


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Prescription's Seized


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Additional Medicare Advantage Members Identification


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U.S. v Alyse Burrell and Horace Mitchell

• Strongest evidence in this case was against BURRELL.

• MITCHELL headed for trial and pled two weeks out after fingerprint was lifted from paper cutter and ATM video showed MITCHELL depositing cash into a dirty account.


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• BURRELL pled guilty to 18 U.S.C. § 1028a Aggravated Identity Theft (predicate offense was Healthcare Fraud) and 21 U.S.C. § 841, 843 and 846 Conspiracy to Acquire Controlled Substances by Fraud and to Distribute Controlled Substances.

• Sentenced to 60 months.


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• MITCHELL pled guilty to 18 U.S.C. § 1028a Aggravated Identity Theft (predicate offense was Healthcare Fraud) and 21 U.S.C. § 841, 843 and 846 Conspiracy to Acquire Controlled Substances by Fraud and to Distribute Controlled Substances.

• Sentenced to 54 months.


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• Washington beneficiaries getting prescriptions filled in Oregon pharmacies.

• Recruiters utilizing low income Medicare / Medicaid beneficiaries to present forged prescriptions and utilize prescription drug benefit to pay. Current investigations involve beneficiaries who have received as much as $500.00 per prescription.

• The most targeted drug is 30mg Oxycodone tablets.

• Current High Forgery Areas in WA are South King County and Northern Pierce County.


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• Use available databases to scrutinize scripts; including your state PDMP database

• If receive a clearly fraudulent script, forged script, ID theft; engage law enforcement immediately

• If you suspect a Medicare provider or beneficiary is diverting, contact – 800-HHS-TIPS or at

– oig.hhs.gov/report-fraud


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Joint case with Social Security OIG

• Davis Adder Edwards

– Stole the identity of his deceased uncle to carry out multiple fraud schemes.

– Applied for and received Social Security Disability under the stolen identity

– Received SSI Benefits

– Received Medicare benefits as a result of being on SSI.

– Worked under another identity.


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• Washington’s Most Wanted Video

Davis Adder Edwards

• Medicare (you the taxpayer) paid over $175,000 for Edwards’ medical care.


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Thank You!

Robin Bonn

Special Agent

US DHHS/OIG/OI, Portland, OR

TEL: 503-326-5039

Email: [email protected]


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medical identity theft - hcca-info.org · • recognize the different types of medical identity...

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