The United States Attorney for the Northern District of Alabama announced on August 28th that Isaac Earl Smith, 38, and Annetra Poole-Moore, 37, have agreed to plead guilty to federal crimes involving healthcare fraud, disclosures prohibited by the Health Insurance Portability and Accountability Act (HIPAA), and aggravated identify theft.
Between 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, Moore was employed by UnitedHealthcare Inc. (“UHC”) as a claims representative associate. There, 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”).
The defendants and others used this information to create counterfeit prescriptions. These prescriptions were then presented to pharmacies for the purpose of illegally obtaining controlled substances, which 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, costing the FEHBP almost $73,000.
Smith 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 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.