Cedars-Sinai worker gets prison for stealing patient records

A former Cedars-Sinai Medical Center employee was sentenced to four years, eight months in prison after pleading guilty today to stealing patient information to defraud insurance companies of $354,000.

The hospital had sent letters in December to more than 1,000 patients, warning them that their personal information had been found during a search of the home of James Allen Wilson, who worked in the billing department between 2003 and 2007.

 Wilson was charged with using the information of 12 of the victims, all of them Los Angeles Unified School District employees who had filed workers' compensation claims, to bill insurance companies more than $1.3 million for medical treatment that was never provided.

The scam netted him $354,000, said Deputy Dist. Atty. Wendy Derzaph of the Healthcare Fraud Division. The affected companies include: Sedgwick CMS , Specialty Risk Services, Continental Casualty Co., Liberty Mutual, Southern California Regional Management Assn., Travelers and Zurich Insurance, said Jane Robison, a spokeswoman for the Los Angeles County district attorney's office.

Wilson, 45, of Los Angeles, had initially pleaded not guilty to multiple felony charges.

But after hearing evidence against him on the first day of a preliminary hearing last week, he pleaded guilty to one count each of identity theft, insurance fraud and grand theft, along with two counts of failure to file income taxes in 2005 and 2007, Derzaph said in a statement.

In addition to the jail term, L.A. County Superior Court Judge Samuel Mayerson ordered Wilson to pay $354,000 in restitution to L.A. Unified, which paid for treatment that employees never received, and $62,000 in back taxes and penalties to the state Franchise Tax Board, the statement said.

-- Alexandra Zavis

Comments

[Angela Shelley]

I don't understand how he made money from defrauding money that was paid to Cedars?
How did he end up with cash.
Confusing article.

[Rick]

He deserves the sentence he recieved. He abused his position as an employee in the billing department. This seems to be happening more and more. How don't understand how people like him think they can get away with something like this. It might take time but, eventually, you are going to get caught.

[Larry Medina]

I'm unsure of how he was able to get the $354k as well- this doesn't make much sense.

It also doesn't say whether this information that was appropriated was taken from paper based records or from electronic systems. And while that MAY NOT SEEM TO MATTER much, it actually is relevant, especially with the recent claims that electronic health records will result in lower costs for insurance, etc.

Granted, people will be people, but there should be safeguards in place that disallow the individuals who work in medical billing to do anymore than 'view' records of patients. They shouldn't be allowed to download or print those records, the functions should be separated to prevent this type of abuse.