Fake Doctor Sentenced for Health Care Fraud and Criminal HIPAA Violations

ATLANTA—MATTHEW PAUL BROWN, 30, formerly of Atlanta, Georgia, was sentenced this week by United States District Judge Amy Totenberg to over five years in prison on charges of health care fraud and wrongful disclosure of individually identifiable health information.

United States Attorney Sally Quillian Yates said, “Unlike most fraud cases, which endanger the bank accounts and financial soundness of victims, this defendant’s fraud scheme also placed his victims’ health at risk. While posing as a doctor, he treated over 1,100 patients. His crime defrauded those individual victims of the care they deserved, and defrauded Medicare, Medicaid and private health insurance companies of funds intended and needed for legitimate health care.”

FBI Atlanta Special Agent in Charge Brian D. Lamkin said, “The FBI remains committed to investigating these types of health care fraud matters, to include fraud against private health care companies and medicare fraud. Individuals such as Mr. Brown, who attempt to profit through such fraudulent schemes at the expense of others who truly rely on these programs for their health care will remain as the priority focus of the FBI’s health care fraud efforts.”

BROWN was sentenced to five years and 10 months in prison, to be followed by three years of supervised release, and ordered to pay restitution totaling $1,063,004. On September 14, 2011, BROWN pleaded guilty to 16 counts of health care fraud, as well as one count of wrongful disclosure of individually identifiable health information, in violation of the Health Insurance Portability and Accountability Act (“HIPAA”).

According to United States Attorney Yates, the charges, and other information presented in court: From November 2009 through April 5, 2011, BROWN carried out a health care fraud scheme in the metro Atlanta, Georgia, and Nashville, Tennessee, areas. While operating in the Atlanta area, from November 2009 through August 2010, BROWN approached numerous practicing physicians and persuaded them to bill Medicare, Medicaid, and private health insurers under their own provider numbers for allergy-related care provided by BROWN. The care was provided both at the physicians’ own offices and at health fairs, with the physicians agreeing to pay BROWN between 50 and 85 percent of a total of approximately $1.2 million they received from the health care benefit programs. BROWN has never been licensed in Georgia as a physician, physician assistant, nurse practitioner, or clinical nurse specialist.

The investigation did not indicate that any patient who received care from BROWN was seriously injured by the care. The evidence gathered reflected that BROWN had purchased the needles and allergy shots from a legitimate commercial pharmacy and that BROWN ever used unsterile needles for the shots.

The individually identifiable health information wrongfully disclosed by BROWN, according to the evidence, was a spreadsheet he created with information concerning each person he treated. BROWN sent the spreadsheet to an undercover FBI agent, who BROWN believed to be an investor considering a large investment in BROWN’s business.

The U.S. Attorney’s Office has notified the individuals treated by BROWN, to the extent it was possible to identify and locate them.

This case was investigated by special agents of the Federal Bureau of Investigation. Assistance has been provided by the City of Duluth Police Department.

Assistant United States Attorney Alana R. Black prosecuted the case.

For further information, please contact Sally Q. Yates, United States Attorney, or Charysse L. Alexander, Executive Assistant United States Attorney, through Patrick Crosby, Public Affairs Officer, U.S. Attorney’s Office, at (404) 581-6016. The Internet address for the HomePage for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.