Tag Archives: Chicago health law and litigation

How safe is your day or med spa, and what do you know about regulations?

Illinois LicenseTechnology has increased the options in cosmetic health and wellness beyond the days of plastic surgery being the main alternative procedure when face creams and treatments fail to do the job. Today we can go to an esthetician at a medical spa for laser treatments and Botox injections with as much ease as going to get a haircut. While Day and Med Spas are becoming increasingly popular, so are the occasional news report of a problem with a service or treatment. Would you know whether the person performing skin laser treatments is required to be licensed and at what level? Is the person working with you covered by their malpractice insurance? To whom would you make a complaint? The more information we know about the law and Med Spas, the better we can use these facilities and share knowledge with one another.

The Illinois Department of Financial and Professional Responsibility (IDFPR) regulates medical spas.

There are several Esthetician[i] professions regulated and licensed by the IDFPR. These state licensed health and wellness professionals must complete specific education requirements and pass state required examinations to obtain their professional license required to practice.

Esthetic services provided at day and med spas are “treatments that affect layers of skin below the surface or treatments that affect other soft tissues of the body, or which are injected (Botox) or removed from the body (liposuction) are medical procedures that which require direct medical supervision. These procedures should only be performed by a licensed cosmetologist or esthetician.

What may happen when injuries or damages occur at a med spa?

In 2010, the IDFPR issued a news release warning the public to be more aware of spa treatments that can be performed by a licensed cosmetologist or an esthetician.[ii] With an increase in day and med spas, there are more people new to using these types of services, who may be at risk of “infections or injuries caused by untrained or unsupervised attendings performing what, in some cases, are actual medical procedures.[iii]

In the event of injury or infection, a patient may seek reimbursement for damages directly or through and insurance claim or lawsuit. If the damages are a result of medical procedures performed by an untrained or unsupervised attendant, and not the licensed cosmetologist or esthetician, there could be additional investigations and discipline on the behalf of the state, through the IDFPR and other authorized agencies.

About the American Med Spa Association and its resources

To learn more about the day and med spa treatments, particularly those considered medical procedures requiring a licensed esthetic professional, the American Med Spa Association (AmSpa) website for Illinois offers answers to frequently asked questions by the consumers of day and med spa services. The site covers issues involving federal, state and local laws and regulations, as well as FDA and DEA information about the substances and products used in treatments.

If you have more questions about day and med spas in Illinois and want to learn more, contact the health law firm of Michael V. Favia & Associates in Chicago.

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] “The practice of esthetics covers a wide array of techniques that may include (but certainly is not limited to) steaming, waxing, extraction, chemical peels, and pore cleansing.” http://www.estheticianedu.org/what-is-an-esthetician/

[ii] IDFPR News Release: State Warns Holiday Shoppers to Remember: Safety First, Many Day and Med Spa Treatments Need Doctor Supervision. Dated December 15, 2010.

[iii] See HNii above.

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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

Dr. Whistleblower: Reporting $10 million in a Medicare billing fraud scheme, could share in recovery

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

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

Former CEO of a physician-hospital practice venture, Robert Dannenhoffer, MD, filed a lawsuit in federal court alleging his former employer terminated the doctor’s position in retaliation for Dannenhoffer reporting a $10 million Medicare fraud scheme. Dr. Dannenhoffer led investigators to discover a fraudulent payment scheme, by which doctors were being compensated more money in exchange for prescribing certain medical procedures and prescription medications to Medicare patients, regardless of whether they were necessary, according to reports. The lawsuit alleges violations of the False Claims Act and the Stark Act, a federal patient referral law. As a whistleblower under federal law, Dr. Dannenhoffer seeks and may be entitled to the reinstatement of his position, back pay, punitive damages and attorney’s fees.[i]

Medicare Fraud is often reported and exposed by whistleblowers who may share in court awards.

Medicare fraud costs U.S. taxpayers significant money every year when fraudulent reimbursements and overpayments are claimed and paid for treatments never provided to patients, suppliers billing for equipment never obtained and even the use of false information to mislead an individual to joining a Medicare plan. Doctors in physician-hospital practice ventures, like Dr. Dannenhoffer, may be liable for Medicare fraud occurring in their practice, even despite their potential lack of personal knowledge. By reporting the suspected fraudulent behavior as a whistleblower, a physician like Dr. Dannenhoffer not only may avoid liability for fraud, they may recover a percentage of any amounts for which the case settles or for which a judge rules in favor of the government.

Dr. Dannenhoffer is the whistleblower in this Medicare fraud scheme in which over $10 million worth of fraudulent and inflated Medicare payments are identified. The doctor claims that after he filed his federal whistleblower lawsuit, he was fired as CEO of the major healthcare provider where he worked and was blacklisted in the medical community.

The doctor claims his healthcare company violated the False Claims Act and the Stark Act.

False Claims Act violations are not taken lightly. In this case, Halifax Health settled for $85M.

False Claims Act violations are not taken lightly. In this case, Halifax Health settled for $85M.

Federal law codified in the False Claims Act (FCA)[ii] imposes liability on individuals and organizations, often federal contractors, who defraud government programs such as Medicare. The FCA, imposes damages and penalties for any individual who knowingly submits or causes another to submit a false claim to the government, or knowingly makes a false record or statement to obtain a false claim paid by the government. The current amounts of penalties can amount to three times the dollar amount of the claim plus fines of $5,500 – $11,000 per claim.

An individual reporting Medicare fraud may also file an intervening lawsuit on behalf of the government, a qui tam action, and the whistleblower’s identity is kept under seal. The whistleblower may share in the financial settlement or recovery, between 15 and 25 percent of the amount. The law works this way to encourage more individuals to step forward and report Medicare fraud.

The Stark Law[iii] is a section of the Social Security Act and is known as the physician self-referral law. Physicians may not make referrals and receive payment Designated Health Services[iv] payable by Medicare to an individual or group where the physician or their immediate family member are an owner or have an ownership interest. In this case, Dr. Dannenhoffer was not allowed to make referrals to the organized medical service venture in which he was a partner with interest.

Being a whistleblower has its costs, but it is better to discover and report Medicare violations, than to worry about civil and criminal liability for participating or failing to report fraud.

The laws involving fraud are frequently tightening and are stricter in the enforcement of the False Claims Act.

The laws involving fraud are frequently tightening and are stricter in the enforcement of the False Claims Act.

Michael V. Favia and Associates can help physicians who learn or receive notice of Medicare fraud activities. With many local, state and federal agencies working together to investigate and stop health care billing fraud, reporting a violation as a whistleblower may be the only option an individual has when they otherwise could face civil and criminal liability and penalties, including imprisonment. Of course, Favia and his team can also offer physicians a review of their billing procedures and protocols to assess risk and exposure to potential fraud. When your chain is only as strong as its weakest link, it makes sense to regularly examine that chain.

Chicago health law, litigation and professional licensing attorney, Michael V. Favia and the associate attorneys of Michael V. Favia and Associates, P.C. represent 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 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] Beckers Hospital Review, Ex-CEO claims retaliation for blowing the whistle on $10M in false Medicare charges, by Ayla Ellison, Jan. 27, 2016.

[ii] The False Claims Act 31 U.S.C. §§ 3729–3733

[iii] The Stark Act 42 U.S.C. § 1395nn

[iv] Designated Health Services under the Stark Law