Category Archives: Civil Litigation

Michael V. Favia joined panelists speaking at 8th Annual Illinois Administrative Law Conference

The Illinois Bureau of Administrative Hearings recently held its 8th Annual Illinois Administrative Law Conference, focusing on training specifically geared toward the distinct functions of State adjudicators and those involved in the practice of administrative law before State hearings units.

Speaking at the full day conference, Michael V. Favia[i] joined colleagues, Carrie Chapman[ii] and Mary Kathryn Curry[iii] to present as the Practitioner’s Panel, sharing the view from the counsel table, talking about the legal issues and elements of administrative law cases that attorneys address in litigation and defense of individuals at State hearings.

The conference welcoming and introduction was delivered by general counsel for Gov. Rauner, Dennis Murashko, who introduced the keynote speaker, Hon. Rita Garman, Illinois Supreme Court Justice.

Subjects in the conference training included:

  • Cultural Competence in Administrative Law
  • View from Counsel Table: Practitioner’s Panel
  • The Role of the ALJ: Procedural Fairness and the Administrative Process
  • Evidence for ALJs
  • Central Panels in the U.S.
  • Ethical Issues Facing ALJs

Use this conference press link for more information about this conference and names of individual panelists and speakers.

About us: Michael V. Favia & Associates, P.C. is a health law, litigation and licensing firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. Michael V. Favia & Associates is available at (773) 631-4580. Please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

[i] Michael V. Favia is the principal attorney at Michael V. Favia & Associates, P.C., a health law, litigation and licensing firm.

[ii] Carrie Chapman is the Director of Policy Advocacy and Strategic Innovation for the Legal Council for Health Justice

[iii] Mary Kathryn Curry is an associate attorney at the Polsinelli law firm in the area of labor and employment defense and litigation

Nursing home liability for mechanical failure and patient injury

Nursing home administrators and management work diligently to protect the health and safety of residents. Despite everyone’s best efforts and rendering the best care, accidents can happen, and can be the result of mechanical failure. One of the tasks performed by healthcare staff during routine care should be the inspection and maintenance of mechanisms used in the care of nursing home residents. For example, a mechanical lift, should be inspected to insure proper working condition so as to prevent a lift device failure leading to a fall and injury. In the event the nursing home fails to maintain equipment or knowingly fails correct a mechanical failure, the result of an injury to a resident can be a lawsuit resulting in findings of negligence.

Nursing Home Care Act: Was the condition or occurrence the proximate cause of injury or death?

If there is a condition or occurrence which is the proximate cause of injury, the individuals or organization can be found liable for negligence within the scope of the Illinois Nursing Home Care Act.[i] Within the Act there is a section describing a “safe resident handling policy[ii],” and requiring a policy to prevent injury due to mechanical failures. The policy requirement is listed in the Act as follows: “A facility must adopt and ensure implementation of a policy to identify, assess, and develop strategies to control risk of injury to residents and nurses and other health care workers associated with the lifting, transferring, repositioning, or movement of a resident.[iii]

The safe resident handling policy should be followed and documented on a regular and consistent basis. Good recordkeeping and policy adherence is important, especially in the event of an injury or death and investigation in to the customs and practices used and whether a stated policy was followed or there was negligence leading to the injury or death.

Mechanical failures can include wheel chair lift failures and much more. Education and policies are essential.

While the Nursing Home Care Act specifically addresses wheel chair lifts and the importance of maintenance and insuring the mechanical fitness of equipment, there are many additional safety concerns and possibilities of mechanical failure. The proper operation of medical equipment used in the delivery of medicine, respiration machines, video resident monitoring are all important and can lead to injury and death. Make sure all mechanical equipment being used to lift, move and provide care for residents is working properly. It is important to maintain documentation of equipment checks for wear and damage.

Educating nursing home staff is important. Making sure the entire organization is trained on maintaining proper safety policies can help reduce the risk of resident injury and death.

Failure to maintain resident safety policies and failure to prevent the risk of injury through mechanical maintenance can lead to state discipline and fines.

The Illinois Department of Public Health and the Illinois Department of Financial and Professional Regulation can become involved in situations involving the injury or death of a nursing home resident. If nursing home administrators, managers or staff are found to have violated the law, there can be fines, professional discipline and more adverse consequences. In some cases, nursing homes can be closed.

The time to talk to a health care and liability and licensing attorney is before an accident happens. An experienced health care attorney can help nursing homes create policies and protocols that satisfy legal requirements so that the nursing home administration can establish its best efforts at satisfying its duties of care to residents. In the event there is an accident, also call a health care attorney to discuss important next steps.

About us: Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. Michael V. Favia & Associates is available at (773) 631-4580. Please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

 

[i] 210 ILCS 45/1-101 et seq.

[ii] 210 ILCS 45/3-206.05

[iii] 210 ILCS 45/3-206.05(b)

Experience matters: Hiring the best healthcare licensing lawyer

How much did it cost you to become a licensed and practicing healthcare professional? While doing the math, in addition to the hard cost of tuition for many years of school, remember to include the opportunity cost of all else you may have done to earn money while you dedicated your life and career path to healthcare practice. In addition to money, the time and other resources invested in a healthcare practice are significant. It is safe to say that healthcare professionals have too much to lose to gamble with a licensing dispute or discipline.

There appears to be an increase in the coverage of healthcare discipline and regulation.

Doctors, dentists and nurses all understand that frivolous complaints are filed from time to time and the regulatory agency charged with oversight has a duty to follow up on any and all reported incidents. Even if you assume you are in the clear and can handle everything on your own, it is possible to stumble on an unknown regulatory or legal issue and it is never good to be caught off guard when defending your practice.

There are incentives for people to report the alleged misconduct of others, particularly in healthcare practice. Consider the amount of coverage given to cases of Medicare billing fraud. People who report Medicare fraud can receive compensation for being the whistleblower. A less than ethical individual may target practitioners with high volume practices if they think there is a chance an error may lie somewhere in the billing files, and they might get lucky.

When winning and defending your practice matters, so does experience.

The increase in demand for healthcare professionals leads to an increase in all the industries supporting healthcare practice, including the legal industry. As increased manpower and technology allows for more opportunities to regulate and oversee healthcare practices, there is an increased need for skilled and experienced attorneys to advise and represent licensed healthcare practitioners.

Chicago healthcare law and licensing attorney, Michael V. Favia humbly finds himself among the best healthcare attorneys in the State of Illinois. Favia’s career has afforded him the opportunity to work for the State as well as in private practice, on both sides of the fence. As a former chief prosecutor for the IDFPR, then the Illinois Department of Professional Regulation, Favia is intimately familiar with the outlook and position of the Department, when it investigates and makes discretionary decisions whether to proceed with the investigations that can lead to discipline and serious consequences.

Read Michael V. Favia’s LinkedIn profile for a full list of career accolades and experience.

Working in private practice, counseling and representing Illinois-licensed healthcare practitioners, defending their licenses and careers, Favia has also had the opportunity to share experience and wisdom with other attorneys learning healthcare law. Only through many years of experience in the trenches does a professional develop the right intuition and knowledge base to be the senior practitioner to mentor others. In building his career, Favia has worked with other leading healthcare lawyers, associating and collaborating on cases; he is the one they turn to when they need additional counsel.

About us: Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. Michael V. Favia & Associates is available at (773) 631-4580. Please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

Favia will work with the firm’s members in the Chicago office and nationwide on professional licensing matters.

Dedicated Medicare Compliance Practice: The QPWB Advantage, Michael V. Favia, Of Counsel

Michael V. Favia and Michael V. Favia & Associates, P.C., are Of Counsel to Quintairos, Prieto, Wood & Boyer, P.A. (QPWB), the full-service business law firm with offices located in several U.S. states and overseas.[i] QPWB maintains a Dedicated Medicare Compliance Group and works with insurance carriers in connection with direct and indirect claims involving Medicare reimbursement. Because attorney Favia and the firm are Of Counsel to QPWB, the firm has access to the benefits of this advanced compliance practice group.

There are a variety of services QPWBs compliance group can offer to self-insured companies and insurance carriers with worker’s compensation and liability claims. How and when to pay claims and submit reimbursements to Medicare can be daunting when mistakes can result in bad faith claims and unanticipated economic losses.

The QPWB Dedicated Medicare Compliance Group can assume a variety of responsibilities for insurance clients, including without limitation, claim investigation, conditional payment negotiation, and funding submissions where future medical expenses are certain or likely. Because every client and claim is unique, the QPWB group uses a proprietary system to properly assess and manage each and every claim.

“The QPWB Advantage:

  • We address each claim on its own merits and not in a cookie cutter manner;
  • As attorneys, we act as advocates on behalf of our clients focusing on every factual, legal and medical argument to help develop strategies to reduce exposure;
  • We make realistic recommendations so that clients can make informed decisions and work towards understanding and resolving compliance issues in the most economical fashion;
  • The firm provides attorneys with decades of experience in counseling self-insured and insurance clients;
  • Decades of experience meeting with opposing parties and attending Administrative and Judicial pre-trials to address compliance issues.
  • We provide individualized attention to the needs of our clients, from the smallest matter to the largest.[ii]

In addition to direct claim management, QPWB works with external vendors and attorneys focused on primary payer issues, cost projections, medical arguments and claim settlements.

For more information about direct and indirect insurance claims and Medicare compliance, please contact Michael V. Favia & Associates, P.C.

About us: Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. Michael V. Favia & Associates is available at (773) 631-4580. Please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

[i] QPWB office locations are located in Arizona, California, Florida, Georgia, Illinois, Michigan, New York, Texas, and in the U.S. Virgin Islands.

[ii] See QPWB’s website for more information about the Dedicated Medicare Compliance Practice.

PODCAST: Nurse Consulting and Litigation Assistance with Samantha Glon

Today’s podcast interview with nurse consultant, Samantha Glon, focuses on current trends and topics in the area of nurse consulting and litigation assistance in healthcare related cases. In the next 30 minutes Samantha will talk to us about her career in nurse consulting work in general and in the legal practice areas including tort liability, malpractice consultations and nursing home and medical practice investigations. CLICK/TAP HERE TO LISTEN NOW!CLICK/TAP HERE TO LISTEN NOW!

Topics covered in this 30-minute interview:

  • Introducing nurse consultant, Samantha Glon, RN, BS, ALNC, FCEA
  • Career focus on nurse consulting, what type of work is involved?
  • What skill sets and experience are important in reviewing medical charts?
  • Litigation assistance in healthcare related cases involving (1) tort liability, (2) malpractice consultations, and (3) nursing home and medical practice investigations.
  • Tips for people looking for a career change and have an interest in nurse consulting?

 

Samantha Glon, RN, BS, ALNC, FCEA, is the founder and owner of SJG & Associates, the legal nurse consulting and medical records review provider for attorneys, insurance companies, and healthcare facilities. Samantha has significant work experience as a Registered Nurse and in healthcare and nursing director positions. Samantha earned her Associates of Science Degree in Registered Nursing from Elgin Community College and she earned her Bachelors of Science Degree in Healthcare Management from National-Lewis University.

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Michael V. Favia & Associates are available to advise and represent health care professionals and the general Chicagoland community 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.

Illinois Professional Licensing Consultants 5

For more about Michael V. Favia & Associates’ professional licensing work, please call (773) 631-4580, visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You may also connect with Attorney Michael V. Favia on LinkedIn and on Avvo.com where you may also read client endorsements and reviews.

Home health, the Illinois Elder Abuse and Neglect Act, reporting laws

One of the most difficult decisions we can face as adults is what to do when our parents can no longer take care of themselves and need professional healthcare and daily living assistance. In recent years, home healthcare is an option many pursue so mom or dad can stay home in the safety and comfort of their own environment. Residential home boarding facilities, are similar to licensed nursing homes and are also an option when the resident has more immediate health concerns and may require more attention. The State of Illinois Department on Aging mission statement is, “to serve and advocate for older Illinoisans and their caregivers by administering quality and culturally appropriate programs that promote partnerships and encourage independence, dignity, and quality of life.” [i] The state publishes a guide containing relevant laws and other resources for families of senior citizens, The Elder Abuse and Neglect Act and Related Laws.

About the Illinois Elder Abuse and Neglect Act

Abuse is defined by the Elder Abuse and Neglect Act (Act) as meaning, “causing any physical, mental or sexual injury to an eligible adult, including exploitation of such adult’s financial resources.” The Act covers eligible adults, defined as, “a person 60 years of age or older who resides in a domestic living situation and is, or is alleged to be, abused, neglected, or financially exploited by another individual or who neglects himself or herself.” The required domestic living situation is, “a residence where the eligible adult at the time of the report lives alone or with his or her family or a caregiver, or others, or a board and care home or other community-based unlicensed facility, but is not [a licensed Nursing Home, or other regulated facility as identified in the Act].[ii]

The focus of the Act, is the location of the elder resident, often at home or an unlicensed and unregulated board home or care facility outside the traditional nursing home system. The licensed nursing homes are covered under separate state laws which direct the reporting of elder abuse and neglect, but the residential and home health operations have no such laws, but for the Act which identifies people who are mandated reporters, to the authorities, of elder abuse and neglect at home or in a local residential boarding home, for example.

About mandated reporters and the elder abuse provider agencies

The Act identifies mandated reporters who are subject to legal liability if they fail to report incidents of elder abuse and neglect. These individuals are those who work professionally in the fields of social services, law enforcement, education, elder healthcare, and a list of occupations identified in different state laws regulating healthcare professions.[iii]

In the City of Chicago there are several elder abuse agencies to whom reports of abuse or neglect are made, and in Chicago they are organized by Zip Code. The Cook County list of agencies and those in other Illinois counties are listed in the Elder Abuse and Neglect book.

If one of the listed mandated reporters knows or has good reason to believe abuse or neglect is taking place, they are directed to make contact with a provider agency, meaning “any public or nonprofit agency in a planning and service area appointed by the regional administrative agency with prior approval by the Department on Aging to receive and assess reports of alleged or suspected abuse, neglect, or financial exploitation.[iv]

What can you do if you suspect your loved one is being abused or neglected?

Whether you think you may be a mandated reporter, or you have reason to believe your elderly parent, relative or friend is being abused or neglected, you can certainly contact our health law and litigation firm to talk to an attorney who can tell you more about the reporting procedure and what legal rights if any you may have to take action, if it is necessary to protect the best interests of another in care.

We can also talk to you about your questions about liability if you are a mandated reporter and have questions or concerns about abuse or neglect cases that were reported or should have been reported and but were not reported, or were not reported timely.

Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation. We frequently publish information and resources to help healthcare professionals and individual consumers more knowledgeable about news and occurrences in health.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates, call us at (773) 631-4580, please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

[i] Illinois Department on Aging, About us

[ii] Elder Abuse and Neglect Act, definitions, 320 ILCS 20/2(a)-(e).

[iii] Elder Abuse and Neglect Act, mandated reporters, 320 ILCS 20/2(f-5).

[iv] Elder Abuse and Neglect Act, provider agency, 320 ILCS 20/2(h).

Image Source: http://www.illinois.gov/aging/Pages/default.aspx

Illinois physicians and healthcare professionals: Are you prepared in the event of an OIG audit or review?

Not only do healthcare providers need to be concerned with federal compliance with government funded benefit programs like Medicare, there are state compliance agencies who oversee and audit physicians and healthcare systems to make sure there are no shortcomings in the state-funded benefit systems. In Illinois, the Office of the Inspector General (“OIG”) operates as a division of the Illinois Department of Healthcare and Family Services. The OIG’s stated mission is, “to prevent, detect and eliminate fraud, waste, abuse, misconduct and mismanagement in programs administered by Healthcare and Family Services and the Department of Human Services.[i]” The OIG focuses its efforts in fraud prevention, investigations, audits and reviews, sanctions and restrictions, and safety and security.

The OIG in Illinois is highly focused on preventing fraud on the Illinois Medicaid Program and it uses advanced technologies and methods to detect and track activities that could be fraudulent. When possible the OIG conducts preventative verifications of the people and systems involved in tracking medical equipment, the prescribing and delivery of medications and healthcare services.

Illinois Medicaid Fraud Investigations

Fraud can stem from many sources including public aid recipients as well as employees and healthcare service contractors. When a report is made that fraudulent activity may be occurring, the OIG is tasked with investigations to determine if a fraud is being perpetrated on the system. The OIG works closely with a variety of state agencies and authorities to investigate and stop fraud. When an investigation produces significant proof of fraudulent conduct the proper agencies may arrest and bring criminal charges against any individuals involved in defrauding the state.

Audits and Reviews in the Illinois Medicaid Program

In addition to investigating suspected fraud cases, the OIG also conducts a variety of audits and reviews of the Illinois Medicaid System:

  1. Post-payment compliance audits – are all the payments made to Medicaid providers identified and proper?
  2. Quality of care reviews – are proper healthcare services being performed for patients who rely on state funded Medicaid and related programs?
  3. Eligibility reviews – are the people receiving Illinois Medicaid eligible within the system requirements?

What to do if you receive notice of an audit or review by the OIG

In the event the OIG notifies you that they are planning an audit or a review of your healthcare practice, policies and procedures in connection with the application or receipt of reimbursements from Illinois Medicaid or any other program under the authority of the OIG, it is important to immediately contact a healthcare attorney to make sure you are properly organized and prepared to cooperate with the audit or review.

While there may be advanced notice or warning of an audit or review, in cases where a fraud report has been filed with the OIG and they have already been investigating the complaint in the background, the audit might be less routine and more of an evidence gathering exercise. The advice to call a lawyer still applies, and moreover, talking to a lawyer before there is any reason to worry about an audit is a good idea. Just as you maintain a malpractice policy and never plan to use it, maintaining a plan of action in the event of an OIG audit is a prudent move for any healthcare provider.

Michael V. Favia is an experienced healthcare attorney who worked for the State of Illinois and knows first-hand how state investigations and prosecutions proceed and how to properly cooperate.

The former Chief of Prosecutions for the Illinois Department of Professional Regulation, now known as the Illinois Department of Financial and Professional Regulations (“IDFPR”), Michael V. Favia advises and represents healthcare professionals and organizations in a variety of matters, including routine, and not-so-routine audits, reviews and investigations. Favia knows the state regulatory schema and system and can help healthcare professionals craft a plan and be prepared in the event the OIG or another agency comes knocking at their office door.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent licensed physicians in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates, please call (773) 631-4850, visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

 

[i] IL Dept. of Health and Family Services, Office of the Inspector General, mission.