Introduction:
In the intricate world of healthcare, trust and integrity form the bedrock of successful practices. However, even within the most trusted environments, vulnerabilities can be exploited, leading to significant harm to both patients and business operations. This case study explores a complex investigation conducted by F3 Private Investigations, an Orlando-based private investigation agency, into a series of criminal activities—fraud, theft, and embezzlement—perpetrated by a physician assistant (PA) at a high-end medical facility. Our detailed investigation highlights the critical importance of thorough due diligence and robust internal controls to prevent such breaches of trust.
The Case Study: Unveiling the Crimes
Our investigation began when a surgeon and owner of a high-end medical facility in Orlando metro area contacted us with suspicions about a Physician Assistant working directly under him. This individual was committing multiple crimes that jeopardized both the financial health of the practice and the safety of its patients. At the end of F3’s investigations it would be revealed that the PA’s actions included:
- Fraud: The PA engaged in coding fraud to increase collections and qualify for a bonus. This involved submitting false claims to insurance companies, resulting in higher reimbursements.
- Theft: The PA was stealing medications from the office to sell on the black market. This involved taking property (medications) that belonged to the employer without permission, with the intent to permanently deprive the owner of its use.
- Embezzlement: Utilizing her position of trust, the PA embezzled money and medications, betraying her fiduciary responsibilities.
- Drug Diversion: The PA unlawfully redirected prescription drugs from legal sources to illegal channels.
- Tampering: To conceal her theft, the PA diluted medications, compromising their efficacy and endangering patients.
- Insurance Fraud: Submitting fraudulent claims to insurance companies constituted the serious criminal offense of insurance fraud.
Investigative Methods and Tools
To uncover and prove these crimes, our team at F3 Private Investigations employed a range of sophisticated investigative techniques:
F3 Covert Surveillance
One of the initial steps in our investigation was to establish covert surveillance within the office. With the owner’s permission, we posed as an AC repair company entering the office after hours to install hidden cameras in strategic locations. F3, being the only HIPPA certified Private Investigation Agency, ensured these cameras were placed in specific locations to avoid violating HIPAA laws while effectively monitoring the PA’s activities. Our surveillance uncovered the PA’s method of hiding stolen medications in a thermos filled with ice, reminiscent of the scene from Jurassic Park where embryos are hidden in fake shaving cream can.
F3 Financial Forensics
Our financial forensics team played a crucial role in this investigation. By meticulously analyzing billing codes and insurance claims, we uncovered the extent of the coding fraud. The PA manipulated billing codes to increase her take-home percentage and qualify for an annual bonus. This detailed financial analysis provided irrefutable evidence of the fraudulent activities.
F3 Digital and Physical Surveillance
In addition to covert surveillance within the office, we conducted both digital and physical surveillance to track the PA’s movements and interactions outside of work. This allowed us to identify where she was selling the stolen medications and to whom. Our comprehensive surveillance efforts provided a clear picture of the PA’s criminal network and activities.
Preventing Future Crimes: The Importance of Due Diligence
This case underscores the critical importance of thorough background checks and due diligence when hiring employees, especially those in positions of trust. In this instance, a more comprehensive background check would have revealed the PA’s history of suspicious behavior and frequent job changes, raising red flags about her reliability and integrity.
The Need for Comprehensive Background Checks
A standard $30-$50 background check is often insufficient for roles that involve significant trust and responsibility. While the PA had no criminal record, a thorough background check would have uncovered a pattern of moving from office to office under suspicious circumstances. This pattern is unfortunately common in healthcare and other professional settings, where employees may be allowed to resign quietly after committing crimes, avoiding criminal charges to protect the employer’s reputation.
F3 Private Investigations: Your Partner in Prevention
At F3 Private Investigations, we offer comprehensive background checks that go beyond the basics. Our investigations are designed to uncover potential issues before they become significant problems, helping businesses protect themselves from internal threats. By conducting thorough due diligence, we can identify patterns of behavior that may indicate a higher risk of fraud, theft, or embezzlement.
The Investigation Process: Step-by-Step
Our investigation into the PA’s activities followed a systematic process to ensure thoroughness and accuracy:
Initial Consultation and Assessment
The investigation began with an initial consultation with the office owner. We discussed their concerns, reviewed preliminary evidence, and outlined a strategy for the investigation. This initial assessment was crucial in defining the scope of the investigation and identifying key areas of focus.
Covert Surveillance Installation
To gather concrete evidence, we installed covert surveillance cameras in the office. This required careful planning to ensure the cameras were placed in locations that would capture relevant activities without violating privacy laws. The footage from these cameras provided critical evidence of the PA’s theft and tampering activities.
Financial Forensic Analysis
Our financial forensics team conducted a detailed analysis of the office’s billing records. By comparing legitimate billing codes with those submitted by the PA, we identified discrepancies that pointed to fraud. This analysis also revealed patterns in the PA’s coding practices that were designed to maximize reimbursements and personal bonuses.
Digital and Physical Surveillance
In addition to monitoring the PA’s activities within the office, we tracked her movements and interactions outside of work. This included following her to locations where she sold the stolen medications and identifying her buyers. This comprehensive surveillance provided a complete picture of her criminal activities.
Reporting and Legal Action
Once we gathered sufficient evidence, we compiled a detailed report for the office owner. This report included video footage, financial analysis, and surveillance logs. We also provided guidance on how to present this evidence to law enforcement and regulatory bodies to initiate legal action against the PA.
Lessons Learned and Best Practices
This case study offers several important lessons for healthcare practices and other businesses:
Importance of Thorough Background Checks
Conducting comprehensive background checks is essential when hiring employees for positions of trust. This can prevent potential issues and protect the integrity of the business.
Regular Financial Audits
Regular financial audits can help identify discrepancies and prevent fraud. These audits should be conducted by external professionals to ensure objectivity and accuracy.
Surveillance and Monitoring
Implementing surveillance and monitoring systems can help detect and prevent theft and other criminal activities. This should be done in compliance with privacy laws and regulations.
Employee Training and Awareness
Training employees on the importance of integrity and the consequences of fraud can help create a culture of honesty and accountability. Employees should be encouraged to report suspicious activities without fear of retaliation.
Conclusion: Trust F3 Private Investigations
This case study highlights the complexity and seriousness of internal investigations into theft, fraud, and embezzlement. Our expertise in covert surveillance, financial forensics, and comprehensive background checks makes F3 Private Investigations the ideal partner for attorneys, paralegals, and individuals seeking private investigation services in Orlando, Florida.
By choosing F3 Private Investigations, you ensure that your business is protected from internal threats, maintaining the trust and safety that your patients and clients deserve. Contact us today to learn more about our services and how we can help protect your business.
For further information regarding white collar crime in healthcare please visit the FBI’s page on Healthcare Fraud for additional value and context.
