Nurse Practitioner Indicted for Identity Theft, Defrauding More Than $330,000 in Health Care Services
JACKSON, TN—A nurse practitioner has been indicted for forging the signature of a physician on nearly 150 treatment forms, causing Medicare and TennCare to disburse more than $330,000 in payments for unauthorized services.
According to the indictment, from around April 23, 2010 to about June 17, 2014, John Michael Briley unlawfully utilized the identification of a local physician to authorize home health care services for more than 40 individuals. Briley used the physician’s name to order home health care services for Medicare and TennCare recipients 146 times, without the physician’s consent.
Medicare is a federally funded and administered health care program serving people aged 65 and older and others with disabilities. Furthermore, Medicaid is a federal insurance program that provides services to qualifying indigent persons. In Tennessee, the Medicaid program is funded by the federal government and the State of Tennessee, and is referred to as TennCare.
According to the indictment, before Medicare or TennCare can fund home health care services, “Home Health Certifications and Plans of Treatment” forms must be completed. The forms require the signature of a physician as a condition of payment.
Briley is a nurse practitioner, a position not categorized as a physician under federal regulations. Therefore, he forged the signature of a local physician to access home health care services from Medicare and TennCare.
Briley is employed at a private medical practice, Primary Care Specialists-South.
“As the indictment alleges, Briley schemed to defraud the government of health care funding designated for elderly, disabled, and underprivileged citizens,” said U.S.
Attorney Edward Stanton III. “We will remain steadfast in working with our law enforcement partners to bring to justice those who seek to cheat the health care system for illegal gain.”
“This indictment is part of a national health care fraud takedown which involves cases across the country,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services — Office of Inspector General in Atlanta. “The combined effort should assure tax payers that those that steal federal health care dollars will be held accountable for their actions.”
Briley has been charged with one count of aggravated identity theft and 146 counts of making false statements in a healthcare-related matter
If convicted, Briley faces a mandatory sentence of two years’ imprisonment and up to a $250,000 fine for aggravated identity theft. He also faces up to five years’ imprisonment for each of the 146 counts of making false statements, as well as up to a $250,000 fine.
The case is being investigated by the Department of Health and Human Services — Office of Inspector General and the Federal Bureau of Investigation. Assistant U.S. Attorney Matt Wilson is prosecuting the government’s case.
The charges and allegations contained in the indictment are merely accusations, and the defendant is considered innocent unless and until proven guilty.