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DataBank
DCN: 5950000090960771
Process Date: 12/04/2014
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: 01/04/2014
Initial Action
- DEFERRED CONVICTION OR PRE-TRIAL DIVERSION
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 SERVICES NOT RENDERED/SUPPLIES NOT
PROVIDED
LICENSING BOARD
123 CEDAR LANE
ROCKVILLE, MD 20857-0001
JANET DOE
BOARD OFFICIAL
(555) 555-5555
INITIAL
MANN, ANITTA
FEMALE
01/01/1982
GENERAL HOSPITAL
123 CEDAR LANE
ROCKVILLE, MD 20857-0001
GENERAL/ACUTE CARE HOSPITAL (301)
5600 FISHERS LN
ROCKVILLE, MD 20852-1750
NO
***-**-1111
PODIATRIST
SL56, MD
AM111111111
COURT
FEDERAL COURT
ROCKVILLE, MD
ABC123
WANDA CIVIL
CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY
the
DataBank
DCN: 5950000090960771
Process Date: 12/04/2014
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):
DEF123
DEFERRED CONVICTION OR PRE-TRIAL DIVERSION (20)
18 USC 287, FALSE CLAIM (2)
BILLING FOR SERVICES NOT RENDERED/SUPPLIES NOT PROVIDED
(205)
Narrative Description of Act(s) or Omission(s): DOCTOR DID NOT PROVIDE SERVICES TO PATIENTS.
Date of Judgment/Sentence: 01/04/2014
Judgment/Sentence
Restitution Amount:
Other Sentence/Judgment Amount:
Incarceration:
Suspended Sentence:
Home Detention:
Probation:
Community Service:
Other:
X
$ 6,000.00
$ 500.00
Years:
Years:
Years:
Years: 1
Hours:
Months:
Months:
Months:
Months:
Days:
Days:
Days:
Days:
Subject identified in Section B has appealed the reported adverse action.
Date of Appeal: 06/01/2014
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:
12/04/2014
Date of Most Recent Change:
12/04/2014
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.
CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY
the
DataBank
DCN: 5950000090960771
Process Date: 12/04/2014
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
END OF REPORT
CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY
the
DataBank
DCN: 5950000090960772
Process Date: 12/04/2014
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: 01/04/2014
Initial Action
- DEFERRED CONVICTION OR PRE-TRIAL DIVERSION
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)
COURT
FEDERAL COURT
ROCKVILLE, MD
ABC1234
MARY CARES
DEFERRED CONVICTION OR PRE-TRIAL DIVERSION (20)
18 USC. 287, FALSE CLAIM (3)
BILLING FOR MEDICALLY UNNECESSARY SERVICES (310)
CONFIDENTIAL DOCUMENT - FOR AUTHORIZED USE ONLY
the
DataBank
DCN: 5950000090960772
Process Date: 12/04/2014
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): DOCTOR BILLED FOR MEDICALLY UNNECESARRY SERVICES.
Date of Judgment/Sentence: 01/04/2014
Judgment/Sentence
Restitution Amount:
Other Sentence/Judgment Amount:
Suspended Sentence:
Probation:
Community Service:
Other:
X
$ 6,000.00
$ 500.00
Years:
Years: 2
Hours:
Months:
Months:
Days:
Days:
Subject identified in Section B has appealed the reported adverse action.
Date of Appeal: 06/01/2014
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:
12/04/2014
Date of Most Recent Change:
12/04/2014
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
| File Type | application/pdf |
| Author | Denise Nguyen |
| File Modified | 2014-12-04 |
| File Created | 2014-12-04 |