Medical Biller Could Get 12 Years Behind Bars for Meddling with Personal Info

F.J. Thomas

Tampa, FL (WorkersCompensation.com) – Medical billers have access to more critical information than probably anyone else in healthcare. Not only do they have access to a patient’s complete demographic and medical history in order to do their jobs of billing claims and follow up, but most also have access to their provider’s personal and banking information as well. While Tax ID and NPI numbers are the primary sources of verification that insurance companies use, in cases where two providers have similar names, additional layers of identification may also be used, such as date of birth or a social security number. In cases of credentialing, licensing, or hospital privileges, former addresses, employers, and college information is usually required as well.

Although medical billers have access to critical personal information, the average annual salary according to Glass Door and Salary.com is only between $38K to $41K per year. While regular HIPAA violations for accessing patient records outside the regular course of their job does occur, most of the time it is due to curiosity, and in a few cases identity theft of patient information.

While the individual use of personal information for financial gain is not too common among medical billers, and they are subject to monthly background checks by their employers, fraud and theft do periodically happen as in the case of 40-year-old Joshua Maywalt of Tampa, Fla. According to a press release from the Middle District of Florida Department of Justice, medical biller Maywalt was recently charged with 4 counts of aggravated identity theft and 4 counts of healthcare fraud, and could face up to 12 years in Federal prison, as well as forfeit real estate estimated at over $2.2 million.

Maywalt was employed as a medical biller for a company that provided billing and credentialing services for area healthcare providers. He was assigned to a specific provider and was responsible for submitting Medicaid claims for the assigned provider’s charges.

The indictment alleges that Maywalt used patient and the provider’s information to submit claims to Medicaid for services that never occurred. Then Maywalt allegedly altered the provider information on the claim and with the payer so that reimbursement for the false claim was deposited into another account that he personally had control over.

According to information from LinkedIn, Maywalt was the Senior Revenue Cycle Manager at Florida Pain Management starting in July of this year. He obtained his Bachelors Of Science Degree at the University of Tennessee, Knoxville in Finance and Financial Management.

News brought to you by WorkersCompensation.com