Los Angeles physician assistant Ronald Luis Bradshaw, an employee of Glenmountain Medical Group, was convicted of four counts of healthcare fraud, conspiracy to commit healthcare fraud, and aggravated identity theft on June 30 for stealing a doctor’s identity to collect $7.7 million in Medicare payments (United States v. Bradshaw).
A report by the Department of Justice states that from April 2005 to April 2008, Bradshaw ordered tests and prescribed durable medical equipment to Medicare beneficiaries under the apparent supervision of a doctor.
The doctor testified that he had never worked at the Glenmountain facility and that Bradshaw had written the prescriptions using his UPIN without his knowledge.
The Department of Justice and the Department of Health and Human Services have formed the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to combat fraudulent healthcare claims such as this one. HEAT currently has teams in Los Angeles, Detroit, South Florida, and Houston.
MSPs have the ability to help in the battle against healthcare fraud. When credentialing Allied Health Professionals, ask yourself, “Did I remember to confirm the AHP’s supervising physician?” Also, examine current practices at your facility. Do you have best practices and procedures in place for ensuring that UPINs are kept confidential?
Healthcare fraud is costing the system millions of dollars. By asking yourself the two questions above, you can not only ensure that you have verified the identity of an AHP, but you can also prevent the types of fraud illustrated in this case, which drain funding from the beneficiaries who truly rely on Medicare and Medicaid coverage.