Medicare fraud and kickbacks: Chicago psychologist loses his medical license indefinitely

Dr. Reinstein prescribed an alarming amount of clozapine to Illinois patients for kickbacks.

Dr. Reinstein prescribed an alarming amount of clozapine to Illinois patients for kickbacks.

Chicago area psychologist, Michael Reinstein, recently lost his medical license following the Illinois Department of Financial and Professional Regulation (“IDFPR”) suspended his license for a minimum of  three years before Reinstein would be allowed to apply for reinstatement. When complaints of professional misconduct come to the attention of IDFPR, the licensing authority for many Illinois professionals, the IDFPR may cooperate with other state agencies to prevent further harm to Illinois residents. In this case, there was a determination that the doctor received, “Illegal direct and indirect remuneration” from the maker of generic clozapine. Further, reports indicate he did not consider alternative treatments and disregarded their well-being in the name of profit, according to a recent news report.[i]

Generally, the generic drug clozapine is used in the management of antipsychotic disorders, like schizophrenia, when nothing else works. According to a reputable website on pharmaceuticals, this because the drug carries a “concern for the side effect of agranulocytosis [reduction in white blood cell count], clozapine should be reserved for patients who have failed to respond to other standard medications or who are at risk for recurring suicidal behavior.[ii]

The Chicago Tribune published a 2009 story about Dr. Reinstein, highlighting the alarming amount of the antipsychotic clozapine prescribed to his patients. In 2007, he prescribed more clozapine to Illinois Medicaid program patients than, “all doctors in the Medicaid programs of Texas, Florida and North Carolina combined.[iii]

Dr. Reinstein was investigated by the U.S. Department of Justice who accused him of fraud. The U.S. District Court for the Northern District of Illinois stated in a press release that the doctor, “received illegal kickbacks from pharmaceutical companies and submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he prescribed for thousands of mentally ill patients in area nursing homes.[iv]

Medicare fraud is prosecuted under the False Claims Act.

The lawsuit against Dr. Reinstein, the largest civil case alleging prescription medication fraud, is the largest ever brought in Chicago against an individual. The U.S. Attorney’s press release reports that the doctor kept an office in the Uptown neighborhood on Chicago’s north side, where there is a large population of mentally ill nursing home residents. The predatory nature of prescribing strong medications that people might not need, especially when they might lack the capacity to understand and get a second opinion, is in part what is so shocking to people who find out such bad acts were happening so close to home.

The False Claims Act helps expose and prosecute those who make bogus claims for payment through government programs. To encourage people to speak up when they see something wrong, the whistleblowers are rewarded in a percentage of the amount recovered in a successful lawsuit. To learn more about whistleblower protection and the False Claims Act, under which Dr. Reinstein is held accountable, read our article, False Claims Act lawsuits and the whistleblowers who share in recoveries.

The IDFPR, in efforts to protect Illinois residents from wrongdoing professionals, takes action in an effort to protect people against future harms by the individual. You can review the August 8, 2014, IDFPR Order, finding and recommending that Dr. Reinstein’s Physician and Surgeon License be indefinitely suspended for a minimum period of three years. The doctor may wish to apply for reinstatement, but under other recent news we will share in a follow-up article, it is becoming harder to get a professional license reinstated after this type of discipline by the IDFPR.

If you believe you are aware of Medicaid and Medicare fraud, Attorney Michael V. Favia can help.

Michael V. Favia is a health law and litigation attorney whose practice includes IDFPR litigation. Favia is experienced in complex litigation involving government contract and similar types of fraud. Favia’s extensive health care law and litigation career allows him and a skilled group of associate colleagues the benefit of experience in representing clients with qui tam claims for violations of the False Claim Act. Michael V. Favia & Associates are available to help and meet for client consultations with offices conveniently located in the Chicago Loop, Northwest side and suburbs so you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates’ professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

[i] ProPublica, Illinois Suspends Medical License of Leading Prescriber of Antipsychotic Drugs, by Charles Ornstein, Aug. 11, 2014.

[ii] MedicineNet website, clozapine.

[iii] ProPublica, In Chicago’s Nursing Homes, a Psychiatrist Delivers High-Risk Meds, Cut-Rate Care, by Christina Jewett, ProPublica, and Sam Roe, Chicago Tribune, Nov. 10, 2009.

[iv] U.S. Department of Justice, United States Attorney for the Northern District of Illinois, Chicago Psychiatrist Allegedly Submitted At Least 190,000 False Claims to Medicare and Medicaid; Lawsuit Alleges Kickbacks to Prescribe Antipsychotic Medication for Nursing Home Patients, Nov. 15, 2012.

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