Two to plead guilty to fraud, HIPAA violations

Monday, August 31, 2009

United States Attorney Joyce White Vance announced that Isaac Earl Smith, 38, and Annetra Poole-Moore, 37, have agreed to plead guilty to federal crimes involving health care fraud, disclosures prohibited by the Health Insurance Portability and Accountability Act (HIPAA), and aggravated identify theft.

Between about September 2008 and April 2009, Smith, of Pleasant Grove, and Moore, of Midfield, engaged in a criminal conspiracy to commit health care fraud, according to separate plea agreements filed today in U.S. District Court. During that time period, Moore was employed by UnitedHealthcare Inc. (“UHC”) as a claims representative associate. In that position, Moore had access to the personal information, including the means of identification, of certain persons enrolled in Flexible Spending Accounts administered by UHC. Without authorization or approval from UHC, Smith and Moore gained access to the company’s electronic database and obtained names and dates of birth of certain persons who had Flexible Spending Accounts and were also covered by a prescription drug plan sponsored by the Federal Employees Health Benefit Plan (“FEHBP”).

Smith, Moore, and others used this information to create counterfeit and unauthorized prescriptions. These counterfeit prescriptions were then presented to pharmacies for the purpose of illegally obtaining controlled substances. The drugs were then illegally sold to third parties. By using the stolen identities on the prescriptions, the defendants caused FEHBP’s prescription drug plan to pay for the controlled substances, resulting in a loss to FEHBP of $72,746.

Smith’s plea agreement reflects he intends to plead guilty to one count of conspiracy to commit health care fraud, one count of criminally violating the HIPAA disclosure laws, and five counts of aggravated identity theft.

Moore’s plea agreement reflects she intends to plead guilty to one count of conspiracy to commit health care fraud, one count of criminally violating the HIPAA disclosure laws, and two counts of aggravated identity theft.

Smith and Moore have also agreed to pay $72,746 in restitution to FEHBP and to criminally forfeit the same amount.

In addition to the forfeiture, the defendants each face maximum sentences of 10 years in prison and fines of up to $250,000. The aggravated identity theft charges carry two-year minimum prison sentences.

Assistant United States Attorney Lloyd Peeples is prosecuting the matter on behalf of the U.S. Government. The United States Postal Inspection Service, the Food and Drug Administration, the United States Secret Service, the federal Office of Personnel Management, and the Montevallo Police Department investigated the case and joined Vance in making the announcement.

Original Source:
Possibly Related Articles:
HIPAA Breaches
Healthcare Provider
Data Loss Legal breaches
Post Rating I Like this!