Form 9 Criminal Conviction (Guilty Plea or Trial)

the

DataBank

DCN: 5950000090960753
Process Date: 11/25/2014
Page: 1
of
3
MANN, ANITTA
For authorized use by:
LICENSING BOARD

P.O. Box 10832
Chantilly, VA 20153-0832
http://www.npdb.hrsa.gov

MANN, ANITTA
LICENSING BOARD
JUDGMENT OR CONVICTION REPORT

Date of Action: 11/25/2014

Initial Action
- CRIMINAL CONVICTION (GUILTY PLEA OR TRIAL)

A. REPORTING
ENTITY

Entity Name:
Address:
City, State, Zip:
Country:
Name or Office:
Title or Department:
Telephone:
Entity Internal Report Reference:
Type of Report:

Subject Name:
Other Name(s) Used:
Gender:
Date of Birth:
Organization Name:
Work Address:
City, State, ZIP:
Organization Type:
Home Address:
City, State, ZIP:
Deceased:
Federal Employer Identification Numbers (FEIN):
Social Security Numbers (SSN):
Individual Taxpayer Identification Numbers (ITIN):
National Provider Identifiers (NPI):
Occupation/Field of Licensure (Code):
State License Number, State of Licensure:
Drug Enforcement Administration (DEA) Numbers:
Unique Physician Identification Numbers (UPIN):
Name(s) of Health Care Entity (Entities) With Which Subject Is
Affiliated or Associated (Inclusion Does Not Imply Complicity in
the Reported Action.):
Business Address of Affiliate:
City, State, ZIP:
Nature of Relationship(s):

B. SUBJECT
IDENTIFICATION
INFORMATION
(INDIVIDUAL)

C. INFORMATION
REPORTED

Venue (Court):
Jurisdiction:
City, State of Court:
Docket/Court File Number:
Prosecuting Agency or Civil Plaintiff:

Basis for Initial Action
- BILLING FOR MEDICALLY UNNECESSARY SERVICES

LICENSING BOARD
123 CEDAR LANE
ROCKVILLE, MD 20857-0001
JANET DOE
BOARD OFFICIAL
(555) 555-5555
INITIAL
MANN, ANITTA
FEMALE
01/01/1982
LICENSING BOARD
123 CEDAR LANE
ROCKVILLE, MD 20857-0001
CHIROPRACTIC GROUP/PRACTICE (361)
5600 FISHERS LN
ROCKVILLE, MD 20852-1750
NO
***-**-1111

PODIATRIST
SL56, MD
AM111111111

COURT OF THE FOOT
FEDERAL COURT
ANY CITY, MD
ABCDEFG
AB

CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY

the

DataBank

DCN: 5950000090960753
Process Date: 11/25/2014
Page: 2
of
3
MANN, ANITTA
For authorized use by:
LICENSING BOARD

P.O. Box 10832
Chantilly, VA 20153-0832
http://www.npdb.hrsa.gov
Case Number Used by Prosecuting Agency:
Type of Action:
Investigating Agency(Agencies):
Case Number(s) Used by Investigating Agency(Agencies):
Statutory Offense(s) and Count(s):
Act or Omission Code(s):
Narrative Description of Act(s) or Omission(s):
Date of Judgment/Sentence:

CD
CRIMINAL CONVICTION (GUILTY PLEA OR TRIAL) (10)

, ()
BILLING FOR MEDICALLY UNNECESSARY SERVICES (310)
BILLED FOR FOOT CARE AND DIDN'T GIVE FOOT CARE.
11/25/2014

Judgment/Sentence
Restitution Amount:
Other Sentence/Judgment Amount:
Incarceration:
Suspended Sentence:
Home Detention:
Probation:
Community Service:
Other:

$ 1.00
$ 1.00
Years: 1
Years:
Years:
Years:
Hours:

Months: 1
Months:
Months:
Months:

Days: 1
Days:
Days:
Days:

Months:
Months:
Months: 1
Months:

Days:
Days:
Days: 1
Days:

Judgment/Sentence
Restitution Amount:
Other Sentence/Judgment Amount:
Incarceration:
Suspended Sentence:
Home Detention:
Probation:
Community Service:
Other:
X

$ 1.00
$ 1.00
Years:
Years:
Years: 1
Years:
Hours:

Subject identified in Section B has appealed the reported adverse action.
Date of Appeal: 11/25/2014

D. SUBJECT
STATEMENT

If the subject identified in Section B of this report has submitted a statement, it appears in this section.

E. REPORT STATUS

Unless a box below is checked, the subject of this report identified in Section B has not contested this report.
This report has been disputed by the subject identified in Section B.
At the request of the subject identified in Section B, this report is being reviewed by the Secretary of the
U.S. Department of Health and Human Services to determine its accuracy and/or whether it complies with
reporting requirements. No decision has been reached.
At the request of the subject identified in Section B, this report was reviewed by the Secretary of the U.S.
Department of Health and Human Services and a decision was reached. The subject has requested that
the Secretary reconsider the original decision.
At the request of the subject identified in Section B, this report was reviewed by
the Secretary of the U.S. Department of Health and Human Services. The Secretary’s decision
is shown below:

CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY

the

DataBank

DCN: 5950000090960753
Process Date: 11/25/2014
Page: 3
of
3
MANN, ANITTA
For authorized use by:
LICENSING BOARD

P.O. Box 10832
Chantilly, VA 20153-0832
http://www.npdb.hrsa.gov
Date of Original Submission:

11/25/2014

Date of Most Recent Change:

11/25/2014

This report is maintained under the provisions of: Section 1921
The information contained in this report is maintained by the National Practitioner Data Bank for restricted use under the
provisions of Section 1921 of the Social Security Act, and 45 CFR Part 60. All information is confidential and may be used only for
the purpose for which it was disclosed. Disclosure or use of confidential information for other purposes is a violation of federal law.
For additional information or clarification, contact the reporting entity identified in Section A.
END OF REPORT

CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY

the

DataBank

DCN: 5950000090960754
Process Date: 11/25/2014
Page: 1
of
2
FOOTCAREINC.
For authorized use by:
LICENSING BOARD

P.O. Box 10832
Chantilly, VA 20153-0832
http://www.npdb.hrsa.gov

FOOTCAREINC.
LICENSING BOARD
JUDGMENT OR CONVICTION REPORT

Date of Action: 11/25/2014

Initial Action
- CRIMINAL CONVICTION (GUILTY PLEA OR TRIAL)

A. REPORTING
ENTITY

Entity Name:
Address:
City, State, Zip:
Country:
Name or Office:
Title or Department:
Telephone:
Entity Internal Report Reference:
Type of Report:

Organization Name:
Other Organization Name(s) Used:
Business Address:
City, State, ZIP:
Organization Type:
Names and Titles of Principal Officers and Owners (POO):
Federal Employer Identification Numbers (FEIN):
Social Security Numbers (SSN):
Individual Taxpayer Identification Numbers (ITIN):
State License Number, State of Licensure:
Drug Enforcement Administration (DEA) Numbers:
National Provider Identifiers (NPI):
Medicare Provider/Supplier Numbers:
Name(s) of Health Care Entity (Entities) With Which Subject Is
Affiliated or Associated (Inclusion Does Not Imply Complicity in
the Reported Action.):
Business Address of Affiliate:
City, State, ZIP:
Nature of Relationship(s):

B. SUBJECT
IDENTIFICATION
INFORMATION
(ORGANIZATION)

Venue (Court):
C. INFORMATION
Jurisdiction:
REPORTED
City, State of Court:
Docket/Court File Number:
Prosecuting Agency or Civil Plaintiff:
Case Number Used by Prosecuting Agency:
Type of Action:
Investigating Agency(Agencies):
Case Number(s) Used by Investigating Agency(Agencies):
Statutory Offense(s) and Count(s):
Act or Omission Code(s):

Basis for Initial Action
- BILLING FOR MEDICALLY UNNECESSARY SERVICES

LICENSING BOARD
123 CEDAR LANE
ROCKVILLE, MD 20857-0001
JANET DOE
BOARD OFFICIAL
(555) 555-5555
INITIAL
FOOTCAREINC.
5600 FISHERS LN
ROCKVILLE, MD 20852-1750
CHIROPRACTIC GROUP/PRACTICE (361)
MANN, ANITTA
111111111

SL89, MD

FOOTCAREINC2

SUBJECT IS SUBSIDIARY OF AFFILIATE OR ASSOCIATE (600)
FOOTCARECOURT
FEDERAL COURT
ANY CITY, MD
AB
CD
EF
CRIMINAL CONVICTION (GUILTY PLEA OR TRIAL) (10)

, ()
BILLING FOR MEDICALLY UNNECESSARY SERVICES (310)

CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY

the

DataBank

DCN: 5950000090960754
Process Date: 11/25/2014
Page: 2
of
2
FOOTCAREINC.
For authorized use by:
LICENSING BOARD

P.O. Box 10832
Chantilly, VA 20153-0832
http://www.npdb.hrsa.gov

Narrative Description of Act(s) or Omission(s): DIDN'T PROVIDE QUALITY FOOT CARE.
Date of Judgment/Sentence: 11/25/2014
Judgment/Sentence
Restitution Amount:
Other Sentence/Judgment Amount:
Suspended Sentence:
Probation:
Community Service:
Other:
X

$ 1.00
$ 1.00
Years: 1
Years:
Hours:

Months: 1
Months:

Days: 1
Days:

Subject identified in Section B has appealed the reported adverse action.
Date of Appeal: 11/25/2014

D. SUBJECT
STATEMENT

If the subject identified in Section B of this report has submitted a statement, it appears in this section.

E. REPORT STATUS

Unless a box below is checked, the subject of this report identified in Section B has not contested this report.
This report has been disputed by the subject identified in Section B.
At the request of the subject identified in Section B, this report is being reviewed by the Secretary of the
U.S. Department of Health and Human Services to determine its accuracy and/or whether it complies with
reporting requirements. No decision has been reached.
At the request of the subject identified in Section B, this report was reviewed by the Secretary of the U.S.
Department of Health and Human Services and a decision was reached. The subject has requested that
the Secretary reconsider the original decision.
At the request of the subject identified in Section B, this report was reviewed by
the Secretary of the U.S. Department of Health and Human Services. The Secretary’s decision
is shown below:
Date of Original Submission:

11/25/2014

Date of Most Recent Change:

11/25/2014

This report is maintained under the provisions of: Section 1921
The information contained in this report is maintained by the National Practitioner Data Bank for restricted use under the
provisions of Section 1921 of the Social Security Act, and 45 CFR Part 60. All information is confidential and may be used only for
the purpose for which it was disclosed. Disclosure or use of confidential information for other purposes is a violation of federal law.
For additional information or clarification, contact the reporting entity identified in Section A.
END OF REPORT

CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY