Home health care fraud in Bloomingdale, bogus certifications lead to jail time

home health care fraud

Image courtesy of Chicago Sun-Times, Bloomingdale doctor gets two years for Medicare fraud http://bit.ly/1J7HUWX

Home health care facilities can be hotbeds for fraud and prosecutors with their investigators recently put another fraud case in the news. The Bloomingdale-based Home Care Physicians Inc., part-owner and employee, Dr. Arthur Davida, 62, pleaded guilty and received a 2-year sentence in connection with home health care fraud. Physicians engaging in fraudulent activities are not only subject to criminal and civil penalties, they also face discipline by the Illinois Medical Board as well as licensing agencies in any other state in which they are now or in the future wish to practice medicine. While it may be possible to rehabilitate a the career of a convicted physician, it would certainly be an uphill battle.

The increase in popularity of home health care facilities can cause concern for many.

In recent years, home health care has become a well-known and more affordable alternative to traditional nursing and care facilities. Concerns about care and the well-being of their loved ones in nursing facilities make it an easier choice for many families to engage the services of cost-effective home health care operations so their loved ones can stay in their own homes or reside in a home health care residence with one or two other individuals in need of care. Unfortunately, the concerns for proper care and attention are present in home health care situations, just as they are in traditional nursing care facilities. Through increased awareness of the risks and problems in home health care, more family members become aware of situations in which their loved ones could be used as pawns in a fraudulent operation.

In this case, the suburban doctor was alleged to be part of a fraud scheme in with home health agencies who provided patient referrals in exchange for certifications that the patients were confined to homes and not physically or mentally fit to come and go on their own volition. During the course of the investigation by the Medicare Fraud Strike Force, prosecutors from the office of the U.S. Attorney General and the Fraud Section of the U.S. Department of Justice, it was determined that 20 percent of the patients were not confined to their homes. The home health agencies relied on the doctor’s certification that the patients were homebound so that the agencies could bill Medicare for home health care and treatment that those 20 percent of patients did not need. Additionally, the investigation uncovered evidence of billing for unnecessary medical treatments.

Investigators and prosecutors are vigilant in identifying and stopping Medicare fraud.

The cost to Medicare and taxpayers in this case alone totaled at least $4 million according to prosecutors in this case. Imposing the 2 year sentence, U.S. District Court Judge John Tharp, Jr. said this crime is a “very serious offense” involving “stealing money” from Medicare.[i]

The Medicare Fraud Strike Force, overseen by the U.S. Department of Health & Human Services, Officer of Inspector General, established in 2007, combines efforts of the Office of Inspector General, the U.S. Department of Justice, U.S. Attorneys offices, the FBI, private investigators and local law enforcement. Teams of professionals review data and intelligence to identify and stop individuals abusing the Medicare system, bringing them to justice.

This case is relatively recent and as of the date of this blog article, Dr. Arthur Davida is still listed as having a valid medical license in the State of Illinois. Anyone can search for a physician profile on the website of the Illinois Department of Financial and Professional Regulation (IDFPR). A conviction of a crime routinely causes an investigation of a licensed professional, and the due process of law takes considerable time. It is unknown what will happen to this physician’s license to practice medicine in Illinois and other states. According to prosecutors, in his plea agreement the doctor in this case acquiesced to providing the fraudulent certifications for fear the agencies would stop sending referrals.[ii] Cooperation with authorities and prosecutors can make a difference not only in sentencing but in also concerning a professional license.

Chicago health law and litigation attorney, Michael V. Favia, represents Illinois physicians.

Michael V. Favia has a career in law working as a prosecutor and a defender in health care law and litigation. In addition, Favia’s past and current work with the IDFPR touches every element of this case and a variety of fraud-based cases involving Medicare billing for health care services. To learn more about attorney Favia, you may review his professional profile.

Michael V. Favia & Associates are available to advise and represent physicians with a variety of legal issues. With offices conveniently located in the Chicago Loop, Northwest side and suburbs, 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] Chicago SunTimes, Bloomingdale doctor gets two years for Medicare fraud, by Sun-Times Wire, Jan 7, 2016.

[ii] See HNi above.

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