www.providertrust.com
Open in
urlscan Pro
151.101.66.159
Public Scan
Submitted URL: https://providertrust.salesloftlinks.com/t/5297/c/87f24d52-dda9-4d33-a6ea-868da892f3c9/NB2HI4DTHIXS653XO4XHA4TPOZUWIZLSORZHK43UFZRW63JPMJ...
Effective URL: https://www.providertrust.com/blog/ongoing-license-monitoring-critical-to-prevent-healthcare-fraud/?d_utk=c098e9f9-7568-4d03-b...
Submission: On October 06 via api from US — Scanned from DE
Effective URL: https://www.providertrust.com/blog/ongoing-license-monitoring-critical-to-prevent-healthcare-fraud/?d_utk=c098e9f9-7568-4d03-b...
Submission: On October 06 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
POST https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/170311/12f8522f-38fc-4648-b0cc-6d757b618f20
<form novalidate="" accept-charset="UTF-8" action="https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/170311/12f8522f-38fc-4648-b0cc-6d757b618f20" enctype="multipart/form-data" id="hsForm_12f8522f-38fc-4648-b0cc-6d757b618f20"
method="POST" class="hs-form stacked hs-form-private hsForm_12f8522f-38fc-4648-b0cc-6d757b618f20 hs-form-12f8522f-38fc-4648-b0cc-6d757b618f20 hs-form-12f8522f-38fc-4648-b0cc-6d757b618f20_345dd6e6-2898-411b-abd0-8fe180ce0070"
data-form-id="12f8522f-38fc-4648-b0cc-6d757b618f20" data-portal-id="170311" target="target_iframe_12f8522f-38fc-4648-b0cc-6d757b618f20" data-reactid=".hbspt-forms-0" data-hs-cf-bound="true">
<div class="hs_analytics_blog_subscription_web_banner_form hs-analytics_blog_subscription_web_banner_form hs-fieldtype-text field hs-form-field" style="display:none;" data-reactid=".hbspt-forms-0.1:$0"><label
id="label-analytics_blog_subscription_web_banner_form-12f8522f-38fc-4648-b0cc-6d757b618f20" class="" placeholder="Enter your analytics-blog-subscription-web-banner-form"
for="analytics_blog_subscription_web_banner_form-12f8522f-38fc-4648-b0cc-6d757b618f20" data-reactid=".hbspt-forms-0.1:$0.0"><span data-reactid=".hbspt-forms-0.1:$0.0.0">analytics-blog-subscription-web-banner-form</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$0.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$0.$analytics_blog_subscription_web_banner_form"><input name="analytics_blog_subscription_web_banner_form" class="hs-input" type="hidden" value="Blog Subscription Website Banner"
data-reactid=".hbspt-forms-0.1:$0.$analytics_blog_subscription_web_banner_form.0"></div>
</div>
<div class="hs_email hs-email hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-0.1:$1"><label id="label-email-12f8522f-38fc-4648-b0cc-6d757b618f20" class="" placeholder="Enter your Email:"
for="email-12f8522f-38fc-4648-b0cc-6d757b618f20" data-reactid=".hbspt-forms-0.1:$1.0"><span data-reactid=".hbspt-forms-0.1:$1.0.0">Email:</span><span class="hs-form-required" data-reactid=".hbspt-forms-0.1:$1.0.1">*</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$1.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$1.$email"><input id="email-12f8522f-38fc-4648-b0cc-6d757b618f20" class="hs-input" type="email" name="email" required="" placeholder="Enter Your Email" value="" autocomplete="email"
data-reactid=".hbspt-forms-0.1:$1.$email.0" inputmode="email"></div>
</div>
<div class="hs_leadsource hs-leadsource hs-fieldtype-select field hs-form-field" style="display:none;" data-reactid=".hbspt-forms-0.1:$2"><label id="label-leadsource-12f8522f-38fc-4648-b0cc-6d757b618f20" class=""
placeholder="Enter your Lead Source" for="leadsource-12f8522f-38fc-4648-b0cc-6d757b618f20" data-reactid=".hbspt-forms-0.1:$2.0"><span data-reactid=".hbspt-forms-0.1:$2.0.0">Lead Source</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$2.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$2.$leadsource"><input name="leadsource" class="hs-input" type="hidden" value="Blog" data-reactid=".hbspt-forms-0.1:$2.$leadsource.0"></div>
</div>
<div class="hs_gclid hs-gclid hs-fieldtype-text field hs-form-field" style="display:none;" data-reactid=".hbspt-forms-0.1:$3"><label id="label-gclid-12f8522f-38fc-4648-b0cc-6d757b618f20" class="" placeholder="Enter your GCLID"
for="gclid-12f8522f-38fc-4648-b0cc-6d757b618f20" data-reactid=".hbspt-forms-0.1:$3.0"><span data-reactid=".hbspt-forms-0.1:$3.0.0">GCLID</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$3.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$3.$gclid"><input name="gclid" class="hs-input" type="hidden" value="null" data-reactid=".hbspt-forms-0.1:$3.$gclid.0"></div>
</div><noscript data-reactid=".hbspt-forms-0.2"></noscript>
<div class="hs_submit hs-submit" data-reactid=".hbspt-forms-0.5">
<div class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.5.0"></div>
<div class="actions" data-reactid=".hbspt-forms-0.5.1"><input type="submit" value="Subscribe" class="hs-button primary large" data-reactid=".hbspt-forms-0.5.1.0"></div>
</div><noscript data-reactid=".hbspt-forms-0.6"></noscript><input name="hs_context" type="hidden"
value="{"rumScriptExecuteTime":2512.4000000953674,"rumServiceResponseTime":2829.2999999523163,"rumFormRenderTime":1.6000001430511475,"rumTotalRenderTime":2831.4000000953674,"rumTotalRequestTime":315.7000000476837,"isLegacyThemeAllowed":"true","renderRawHtml":"true","embedAtTimestamp":"1665070510457","formDefinitionUpdatedAt":"1660158451866","pageUrl":"https://www.providertrust.com/blog/ongoing-license-monitoring-critical-to-prevent-healthcare-fraud/?d_utk=c098e9f9-7568-4d03-b5aa-f7d17f6131de&sbrc=1ubFQmuJ8W6kbb_f3UgfD1A%3D%3D%24q16fLhzrbKd0dL6JzGlzuw%3D%3D","pageTitle":"Ongoing License Monitoring Critical to Prevent Healthcare Fraud - ProviderTrust","source":"FormsNext-static-5.541","sourceName":"FormsNext","sourceVersion":"5.541","sourceVersionMajor":"5","sourceVersionMinor":"541","timestamp":1665070510457,"userAgent":"Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/106.0.5249.91 Safari/537.36","originalEmbedContext":{"region":"na1","portalId":"170311","formId":"12f8522f-38fc-4648-b0cc-6d757b618f20","target":"#hbspt-form-1665070510205-1565718213"},"urlParams":{"d_utk":"c098e9f9-7568-4d03-b5aa-f7d17f6131de","sbrc":"1ubFQmuJ8W6kbb_f3UgfD1A==$q16fLhzrbKd0dL6JzGlzuw=="},"renderedFieldsIds":["email"],"formTarget":"#hbspt-form-1665070510205-1565718213","correlationId":"ae422b81-4bb8-485c-bdbf-85ca01766a4c","hutk":"7bedcb2db8a4278d67888fd32b295539","captchaStatus":"NOT_APPLICABLE"}"
data-reactid=".hbspt-forms-0.7"><iframe name="target_iframe_12f8522f-38fc-4648-b0cc-6d757b618f20" style="display:none;" data-reactid=".hbspt-forms-0.8"></iframe>
</form>GET https://www.providertrust.com
<form class="modal__search-form" role="search" action="https://www.providertrust.com" method="get" data-hs-cf-bound="true">
<div class="search-form__container">
<input placeholder="Search..." class="search-form__input" type="search" name="s" title="Search" value="" aria-label="Search ProviderTrust website">
<button class="search-form__submit" type="submit" title="Search" aria-label="Search">Search</button>
</div>
</form>Text Content
Search 615-938-7878 Contact
* Platform
* ONE POWERFUL PLATFORM
One monitoring platform, thoughtfully designed for every population.
* * Products
* OIG Exclusion List
* Licenses and Credentials
* SSN Death Master File
* State Board Actions
* CMS Preclusion List
* OFAC SDN List
* View All
* * Services
* CVO Primary Source Verification
* Job Specific Credential Management
* FDR Medicare Compliance
* Attestation Collection
* Vendor Onboarding
* * Solutions
* Employee Monitoring
* Provider Network Monitoring
* Vendor Monitoring
* Referring and Ordering Physician Monitoring
* Use Cases
* USE CASES
Explore our products and solutions in a desired workflow.
* * Providers
* Human Resources
* Procurement
* Provider Compliance
* Revenue Cycle
* Virtual Care
* * Payers
* Credentialing
* Payer Compliance
* Payment Integrity
* Provider Operations
* SIU
* Case Study
How ProviderTrust enabled Amwell to grow 300% during COVID-19
Read More
* Developers
* DEVELOPERS
Integrate your applications with the ProviderTrust platform via API.
* Integrations
Seamless Integrations Designed to Scale
Explore our Integrations
* API Documentation
Full API Reference for Developers
Read our API Docs
* BLOG
SFTP or API: Which is best for your use case?
Read More
* Resources
* RESOURCES
A library of resources and tools, thoughtfully curated for you.
Resource Library
* * Content and Tools
* Blog
* Case Studies
* Guides
* Podcasts
* Webinars
* Exclusion Sources
* NPI Lookup
* GUIDES
Selecting a License Monitoring Solution
Read More
* BLOG
OIG-LEIE, GSA-SAM, and State Medicaid Exclusion Lists: What’s the
Difference?
Read More
* Company
* ABOUT PROVIDERTRUST
Get to know our company and discover your next career.
* * About Us
* Our Company
* Careers
* Culture
* Team
* COMPANY NEWS
ProviderTrust, Inc. Celebrates 12-year Anniversary
Read More
* CULTURE
See why we are a Best Place To Work in Nashville
Explore our culture
Log In Get Started
Back to Resource Library
BLOG
ONGOING LICENSE MONITORING CRITICAL TO PREVENT HEALTHCARE FRAUD
Written by ProviderTrust
September 28, 2022 4min
A 49-year-old Brownsville, TX man, named Fernando Mendez was taken into custody
in early September after being charged with defrauding Medicaid. Mendez, a
physician assistant at CCI Therapy Counseling Centers International, was working
with a suspended medical license.
On July 20th, 2021, the Texas Medical Board allegedly ordered an immediate
suspension of his license after an investigation revealed that Mendez had
violated ethical boundaries by initiating a sexual relationship with a patient.
Deemed a “continuing threat to public welfare,” Mendez was prohibited by the
Board from practicing medicine.
However, despite his suspended medical license, Mendez continued to treat
patients at various mental health clinics in Brownsville, Harlingen, and Pharr,
TX. From August 2021 to February 2022, Mendez provided patient assessments and
evaluations and ordered treatments and prescriptions, all while billing Medicaid
for his services. During this time, Mendez also allegedly created false medical
records and assumed the identity of another physician traveling outside of the
US.
Mendez faces seven counts of healthcare fraud and up to 10 years in federal
prison. Mendez could face an additional two years in prison if convicted of
identity theft, which must be served consecutively to another imposed prison
term. These numerous counts of fraud also carry a possible fine of up to
$250,000.
This prosecution points to the urgent need for healthcare organizations to stay
up-to-date on changes in license status, not just verifying them when they are
about to expire. This means routinely verifying practitioner credentials. If you
are only verifying a license upon hire, annually, or as expiration approaches,
you could miss important eligibility changes, in many cases, risking patient
safety and healthcare fraud.
In Fernando Mendez’s case, the clinics where Mendez practiced with a suspended
license could have become aware of his fraudulent activity much sooner had the
organization more routinely verified the practitioner’s license. Organizations
should conduct background checks on all employees to confirm their licenses are
valid and up-to-date as part of their pre-hire process. As we know, licenses can
be revoked, suspended, or not renewed, so it’s important to conduct routine
license verification checks as opposed to only completing an initial license
verification.
HOW OFTEN SHOULD YOU VERIFY EMPLOYEE LICENSES?
Consistently verifying licenses may be difficult if you do not use a third party
to assist with license and other types of practitioner monitoring, such as
federal and state exclusion monitoring, CMS Preclusion List, Medicare Opt-out,
etc., but consider starting with quarterly verifications. Each licensing board
operates differently, and you will need to do some initial research to determine
what information is needed to verify licenses efficiently. Once your
organization understands the ins and outs of checking each state licensing
board, you can increase your verifications to monthly. Organizations should
download a copy of licenses or take screenshots of verifications for future
audit purposes.
In order to ensure a comprehensive process to verify your practitioners may work
within your organization and ensure compliance across state and federal
regulations, healthcare organizations should monitor important exclusion lists,
including:
* The LEIE issued by the US Department of Health’s OIG
* The GSA-SAM exclusion list
* State Medicaid Exclusion (Sanction/Debarment) lists
REIMAGINE YOUR HEALTHCARE LICENSE MONITORING
An automated license and exclusion monitoring solution like ProviderTrust is an
even more comprehensive way to monitor your providers and protect your
organization against compliance risk. Automated license verification and
exclusion monitoring will screen employees, providers, and vendors against the
applicable licensing board and every state and federal exclusion source up to
daily, so you’ll never miss a licensure issue or exclusion.
By automating your license monitoring and leveraging our always-accurate
compliance intelligence, you can be sure your organization isn’t spending
federal healthcare dollars with unlicensed or excluded providers and in turn,
creates a safer healthcare for all patients.
See Our License Monitoring Solution
TAGS
Licenses and Credentials Medicare and Medicaid Providers
STAY UP-TO-DATE
Subscribe and get the latest news and advice from industry experts delivered
straight to your inbox.
analytics-blog-subscription-web-banner-form
Email:*
Lead Source
GCLID
RELATED RESOURCES
View All Resources
Blog
HOW SERIOUS ARE OIG EXCLUSIONS? KEY INSIGHTS INTO THE FRAUD RISK SPECTRUM
Exclusions OIG Providers
January 26, 2022
Read More
Blog
HHS OIG, GSA SAM.GOV, AND STATE MEDICAID EXCLUSION LISTS: WHAT’S THE DIFFERENCE?
Medicare and Medicaid OIG SAM.gov
March 16, 2022
Read More
Webinars
TOP TEN COMPLIANCE TIPS FOR A SUCCESSFUL 2022
COVID-19 Industry News Medicare and Medicaid
October 28, 2021
Read More
406 11th Avenue N., Suite 250
Nashville, TN 37203
615-938-7878
Contact
Subscribe
* Products
* OIG Exclusion List
* Licenses and Credentials
* SSN Death Master File
* State Board Actions
* CMS Preclusion List
* OFAC SDN List
* State Abuse Registries
* View All
* Services
* CVO Primary Source Verification
* Job Specific Credential Management
* FDR Medicare Compliance
* Attestation Collection
* Vendor Onboarding
* Solutions
* Employee Monitoring
* Provider Network Monitoring
* Vendor Monitoring
* Referring and Ordering Physician Monitoring
* Developers
* API Integrations
* API Docs
* Applications
* Passport
* Dash
* ExclusionCheck
* VendorProof
* About
* Our Company
* Careers
* Culture
* Team
* Resources
Handcrafted with
by ProviderTrust in Nashville, TN
© 2022 ProviderTrust. All rights reserved.
Privacy Policy
Terms of Use
Facebook Linkedin Instagram Youtube Twitter
Search
Menu
Menu
* Platform
* Use Cases
* Developers
* Resources
* Company
Help & Support
615-938-7878 Contact Us
Platform
* Products
* Services
* Solutions
Products
* OIG Exclusion List
* Licenses and Credentials
* SSN Death Master File
* State Board Actions
* CMS Preclusion List
* OFAC SDN List
* View All
Services
* CVO Primary Source Verification
* Job Specific Credential Management
* FDR Medicare Compliance
* Attestation Collection
* Vendor Onboarding
Solutions
* Employee Monitoring
* Provider Network Monitoring
* Referring and Ordering Physician Monitoring
* Vendor Monitoring
Use Cases
* Providers
* Payers
Providers
* Human Resources
* Procurement
* Provider Compliance
* Revenue Cycle
* Virtual Care
Payers
* Credentialing
* Payer Compliance
* Payment Integrity
* Provider Operations
* SIU
Developers
* API Integrations
* API Docs
Resources
* Blog
* Case Studies
* Checklists
* Guides
* Podcasts
* Webinars
* Exclusion Sources
* NPI Lookup
* View All Resources
Company
* Our Company
* Careers
* Culture
* Team
Get Started