We often wonder if health care fraudsters are … normal. Consider Helene Michel, the owner of a DME company in Hicksville, N.Y. As readers of this missive and Medical Practice Compliance Alert are aware, DME is a favorite of crooks and the OIG’s efforts to cut fraud in this area inconvenience honest providers.
 
However, most criminals running a con through a DME company (or a pretend one) are content to enroll in Medicare, have someone trick Medicare patients out of their HICNs and submit fake claims from the comfort of their ocean-going yachts.
 
But not Michel. She did the leg work, impersonating a doctor, nurse and wound care expert in order to get into nursing homes in a five county area. In some instances she accompanied other doctors on their rounds. Why take such a huge risk? To steal patient records of course! How else was she going to submit false claims to Medicare? Sheesh, it would make perfect sense to … another not normal criminal, we guess.
 
Last week she was sentenced to 12 years in Club Fed for health care fraud and HIPAA violations. But we don’t think this is the end of the tale. We suspect the nursing homes might be taken to task for letting her in.
 
It seems like a straightforward HIPAA breach based on our reading of MPCA articles and the HIPAA Answer Book, but we aren’t attorneys. A.J. Plunkett, editor of Environment of Care Leader, notes that hospitals are required to identify individuals who enter their facilities. She was also kind enough to dig out the CoPs for long term care facilities that focus on the steps the facility takes to protect patient records from prying eyes. So it looks like Helene will cause a lot of strife for many parties for some time to come.
 
But we doubt she’ll be name checked in an epic poem.