Insulating your healthcare practice from fraud takedowns

Takedowns are a practice used by federal prosecutors to send a deterrent message to certain industries where the incidence of fraud and criminal activity may be widespread. When federal law enforcement conducts takedowns, they work with law enforcement nationwide and execute the takedowns at the same time. When these takedowns occur simultaneously, there is little warning before an investigator contacts individuals suspected or reported to be engaged in illegal conduct. The healthcare industry is a focus of federal investigators following tips on Medicare fraud. From over billing to treating non-existent or non-qualified patients, Medicare fraud is a compelling problem and task forces are organized and specialized in investigating claims and preparing for nationwide takedowns. Some in the industry predict, based on an increase in enforcement activity, that the Chicago area could be a target for takedowns during the summer of 2017.

The opportunity to insulate your healthcare practice from civil and criminal liability

Awareness of the focus on healthcare fraud leads to an opportunity for healthcare administrators and professionals to review their practices, the trends in fraud, and make any changes to the organization to prevent being targeted in enforcement investigations.

The resources used in using healthcare lawyers to perform health-care fraud and compliance audits are well allocated when the alternative significant civil and criminal fines and penalties could be assessed against your healthcare organization if an investigation leads to adverse findings.

Your healthcare attorney can audit your healthcare systems and help you maintain compliance with federal laws and regulations. Everyone in your administration should be aware of compliance and anti-fraud measures. Being able to demonstrate this preventative practice may be essential in the event of an investigation.

What happens if an investigator visits you and informs you of inquiry

How your hospital or medical practice responds to an initial inquiry of an investigator is imperative. Ahead of time, you should know a healthcare attorney you can contact immediately and you should be aware of how they will advise and represent you if necessary. Even if you believe that your practice is compliant and not in any risk, it is not a good idea to represent yourself without a lawyer when visiting with and responding to investigators.

Your attorney may help satisfy the investigators concerns uniquely, where they know what kind of questions they may ask and how to best communicate your compliance and anti-fraud efforts.

If an investigator contacts you it is important to be polite and offer to assist and comply with their requests. You may ask them for contact information you will give to your attorney to also assist. You do not need to answer any of their questions without your lawyer present. A professional investigator will be accustomed to the request for legal counsel and you should not worry about that looking like any suggestion or admission of wrongdoing or guilt.

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.

 

PODCAST: Appealing adverse final rulings in healthcare discipline, discharge and termination

Today’s podcast interview with attorney Michael Cohen, focuses on his work with attorney Michael Favia in defending healthcare professionals and appealing adverse decisions from any state agency final ruling affecting involving discipline, discharge and terminations. There are many compelling reasons to file an appeal of a ruling affecting your healthcare career. Attorneys Cohen and Favia work as a team to fight for the professional being disciplined or terminated. USE THIS LINK TO LISTEN ANYTIME

Topics covered in this 30-minute interview:

  • Common elements in reportable healthcare discipline, discharge and termination cases;
  • Describing usual procedural processes leading to an appealable final ruling and decision;
  • The measurable impact of healthcare discipline or termination on a local and national level;
  • What to expect in appealing an adverse discipline, discharge or termination ruling.

Michael B. Cohen is a partner in the Chicago office of Quintairos, Prieto, Wood & Boyer, P.A. Mr. Cohen represents clients in a wide variety of civil and criminal litigation matters, both state and federal at the trial and appellate levels, focused on complex commercial litigation. His litigation practice includes the areas of appellate law, bankruptcy, civil rights, commercial, constitutional, criminal, employment, estates and trusts, insurance coverage, medical malpractice defense, personal injury actions, privacy, professional liability, and real estate.

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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.

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.

Michael V. Favia speaks at CBA Administrative Law Committee Meeting Monday March 20

Come have lunch with the Chicago Bar Association Administrative Law Committee on Monday, March 20, from 12: 15 to 1:30 p.m. The topic is “Medical Cases Before the Illinois Department of Financial and Professional Regulation.”

There are many nuances of administrative law and professional regulation that apply in the review of cases involving health care professionals. Being a former Chief of Prosecutions at the IDFPR, then IDPR, Michael V. Favia is uniquely positioned in private practice to advise and represent individuals and organizations involving professional regulatory matters.

Also speaking at Monday’s lunch meeting are Ms. Susan Gold, Deputy Director for State Wide Enforcement, IDFPR, Division of Professional Regulation, and Mr. Donald Seasock, Chief Administrative Law Judge, IDFPR.

Monday’s Administrative Law Committee meeting is held at the Chicago Bar Association, 321 South Plymouth Court and lunch is available for purchase.

Earn Illinois MCLE credit based on the presentation length.

Use this link for more information and to learn how to use the webcast option to attend and earn credit.

 

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.

 

The Illinois Department of Financial and Professional Responsibility investigates cases that can lead to discipline.

Medicare fraud bust in Illinois leads to 6 and ½ year sentence

The biggest problem facing Medicare fraud might be the arrogance of people who get away with bad acts for too long. Meanwhile, with the cooperation of law enforcement agencies using technology and skill, fraud schemes are frequently shut down and bad actors are prosecuted. In some cases, someone on the inside is the whistleblower who notifies authorities. In this case, the nurses who challenged fraudulent behavior were treated poorly and terminated. Several former employees filed whistleblower lawsuits leading to the investigation, arrest and prosecutions in this major Medicare fraud case.

The $90 million Medicare fraud scheme

In this case, Seth Gillman, Chicago businessman and mastermind of this fraud scheme exploited terminally ill patients in Illinois in the $20 million Medicare fraud. Gillman was convicted and sentenced to 6 ½ years in federal prison.

The Chicago Tribune reports, “By paying kickbacks to nursing homes and giving bonuses to employees who took part in the fraud, Gillman built his Passages Hospice LLC into the largest such company in Illinois, serving terminally ill patients in 89 countries and billing Medicare more than $90 million from 2008-2012, government records show.[i]

Unfortunately, Passages Hospice did not provide the care consistent with what Medicare paid in claims submitted for patient services. Meanwhile, Gillman lived a lavish lifestyle, excessive even for a licensed attorney and nursing home administrator. To the U.S. District Court Judge, Gillman stated, “I betrayed the trust of Medicare and I besmirched the integrity of hospice all together…I was stupid and I was wrong.[ii]

Investigation and discovery of Medicare fraud schemes

Why would anyone want to be the whistleblower? When an individual with “clean hands” contacts and works with the investigation of Medicare fraud schemes, they may be removing themselves from the eye of the investigators. Since many of the common Medicare fraud schemes are complex, there are multiple people involved. Therefore, investigators might be looking at everyone involved in a healthcare operation, when there is a suggestion of wrongdoing. It may be easier to report the fraud than be accused of being a part of it or helping with a cover-up.

Another reason people report fraud is they may be able to recover a percentage of fines assessed and paid in connection with the Medicare fraud prosecution.  This is called Qui Tam and our article on point explains the process. See Dr. Whistleblower: Reporting $10 million in a Medicare billing fraud scheme, could share in recovery.

If you or another suspect there may be wrongdoing occurring in a health-related practice or care facility, it is a good idea to talk to a health law and litigation lawyer to figure out where you may stand in the event there is a current or pending investigation. You might also be a proper person to file a whistleblower lawsuit. You might also be an individual responsible for others below you who you believe may be engaged in wrongdoing. Likewise, it is imperative to secure experienced legal 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.

 

[i] Chicago Tribune, Hospice CEO gets 6 ½ years for fraud scheme, by David Jackson and Gary Marx, Mar. 7, 2017.

[ii] See HNi above.

Important documents in health care planning

 

As the baby boomer generation retires and focuses on senior health care and planning for the end of life there are unique opportunities for families to make the right preparations to ensure smooth transitions and reduce the struggling of families trying to make the right decision. Our health care law practice includes drafting wills, living trusts, power of attorney documents and living wills. We are helping our clients prepare for health care challenges during senior years as well as preparing for end of life transitions. When we work together as families when everyone is mentally and physically healthy, we can support one another in major life events without unnecessary anguish. Having all the right health care and estate planning documents prepared make it easier for everyone.

A recent study for the website Caring.com “found only 53 percent of adults reporting having a healthcare power of attorney and only 42 percent reported having a will or living trust.[i]”  

Why is it people wait until someone is sick to prepare a health care power of attorney or will? Why do we otherwise wait until we are planning and overseas trip to prepare these important documents? Most incidents involving injury or death are more likely to occur within a few miles of home. People are learning that health care and estate planning documentation is for everyone, not only the rich.

““Families go through a trauma in decision-making in and of itself,” explained Christine Gorka, director of the Clinical Ethics Center at Memorial Medical Center. “We don’t want (families) to feel like they’ve made the wrong decisions, and they often struggle.[ii]

Wills

If you die without a will in Illinois, the laws of intestate succession determine what happens to the assets in your estate. Your assets and property will go to your wife, children and available heirs in statutorily-determined percentages. This can be difficult for families when there have been remarriages or other blended situations. What happens to your minor children and dependents, if any, is also controlled by a will and final testament. Despite the focus on this article being a senior population, everyone should have a will and should consider the additional documents named in this article, regardless of age.   

Living Trusts

A living trust, also called a “revocable” trust, is a legal document authorizing your assets to be placed in a trust, with named beneficiaries, such as yourself, during your lifetime. After the end of your life, your assets will be directed to your “successor trustees” who would otherwise be the named beneficiaries in your will. There are many options. Some people use a will to determine what happens to certain items like family heirlooms and the remainder of the assets are managed through the living trust.

Power of Attorney for Health Care

A power of attorney document allows you to appoint another person, your agent, to make health care decisions for you if you are unavailable. An example of being unavailable includes a coma or a temporary period of unconsciousness such as during a surgery. If there are complications or decisions that need to be made, the individual with a health care power of attorney can make legally binding health care decisions on your behalf. There are also power of attorney documents that give an individual broader legal authority to conduct basic business, transact banking and pay the bills for an individual who is unavailable or lacks capacity.

Living Wills

A living will is similar to a power of attorney for health care and is used in appointing another individual to make decisions about proper health care and specifically the termination of care under certain conditions. Where lifesaving resuscitation may be required to keep a patient alive, the individual named in the living will have the authority to determine whether to use emergency procedures. This also applies to the decision to terminate medical treatment.

Planning for smooth living in your senior years requires attention to detail when preparing health care and estate planning documents. To learn more about elder and health law planning, please call Michael V. Favia & Associates, P.C. to make an appointment by dialing (773) 631-4580.

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] WANDTV.com, Report: Many adults lack important documents, Feb. 16, 2017, by Joe Strouski.

[ii] See HNi above.

PODCAST: 10 Marketing Tips to Keep Patients Happy and Decrease the Risk of Being Sued

Many health care practitioners think marketing is the sole method to increase the number of patients in a medical practice. Marketing is much more than your collection of brochures and web pages. While our printed materials are important, our brand is really dictated by the opinions of others with whom we interact in our professions. Today we will review a list of 10 cost-effective marketing tips and tactics to boost our brand, keep patients happy and reduce our malpractice risks. Use this link to listen anytime.

Topics covered in this 30-minute interview:

  • Communicating with patients and family members, in and out of the care setting;
  • Respecting the process of patients shopping for ideal health care professionals;
  • Making your office an appealing place to be where patients and their time are valuable;
  • Creating a system to request, receive and respond to patient and family feedback.

Patricia Favia is an award-winning marketing communications and branding professional who is focused on helping health care industry leaders engage their full potential. Ms. Favia works with integrated marketing, communications and advertising to help professionals in the health care industry. In her career in health care marketing, Patricia Favia worked as a director in major health systems in Illinois. She earned her Bachelor’s Degree from DePaul University and participates in the Graduate School of Business, Continuing Education Program at Loyola University Chicago.

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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.

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.

Facing challenges in documenting medical care

Every healthcare professional knows that, at some point in their medical practice, they may be called on to defend patient care. When time passes and our ability to accurately recall information is diminished we should be able to rely on documentation of events to answer questions. There are practices you can adopt that can make it easier to make a good habit of properly documenting everything that happens before, during and after patient care.

Documenting everything is not the only key component to keeping proper records. Your medical record entries must be adequate representations of what happened. Imagine a jury reviewing records in a medical malpractice case, assume they do not spend much of their time reading medical records. How might they react to inadequate records? What may be obvious to you may not be to them. When others are charged with judging your credibility, the quality of your medical records can either enhance or diminish your credibility.

Examples of detrimental documentation practices, as identified in the recently article published by The Doctors Company, The Faintest Ink.[i]

  • Gaps and delays in documentation
  • Illegible entries
  • Dictation with blanks
  • Unflattering or judgmental patient descriptions
  • Entries appearing to vent negative feelings
  • Altered records and records missing documents or entries

To ensure proper documentation, each time and every time, the best practice is to develop a system for entering and recording information. Almost like a checklist, you can determine the rules and procedures for managing information. Identify details regarding when, where, how, what and why information is recorded. While it may seem like extra work, at some point your medical records could be under review and read in isolation of other information. Therefore, every single time it is helpful to identify why an entry is being recorded.

Features and benefits of good documentation habits

Increased communication with patients and increased continuity of care should increase understanding, decrease misunderstanding. In many medical malpractice cases, the root of the problem leading to a complaint can often be identified as failure in the communication process.

One way to improve communication is to use dictation equipment to make your patient notes. When you dictate notes right in front of patients you are more likely to read the details into the notes so that the patient can understand everything. If, on the other hand, you are making dictation and sound cryptic or unclear, a patient could become nervous and worried about not having a clear understanding of their doctor visit.

When making entries, beware of the easy mistakes that you can make when using forms and templates. A simple mistake in recording information on a form can cause problems. If there is an error in checking boxes on one form, could there be more errors on other forms? Making independent notes every time you record patient information better insures accuracy and credibility of information.

It is a good idea to audit and review medical records to ensure that documentation procedures are consistently used. In the audit process, a reviewer may detect entries that may require a second look. If there is an error or missing information, it is always best to make a new record and attach it as an addendum to the original. Do not change or alter records when there is active or pending litigation.

For more tips on documenting patient medical records or if you have questions about exposure and liability in the event of a patient complaint or claim for malpractice, please be in touch with Michael V. Favia and 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] Source for article summary: The Doctors Company, The Faintest Ink, By Carol Murray, RHIA, CPHRM, Patient Safety/Risk Manager II.