Tag Archives: Fraud

Rock Island, Illinois home health supplier faces vendor fraud charges for submitting false billing invoices.

How you can stop home health fraud, Whistleblowers may share in recovery

Home health companies are increasingly popular among families who want their loved one to receive care in their own home or another residential location with others receiving care. Home health options are appealing to those who do not favor the traditional nursing home facilities and find them to seem institutional. One advantage of a traditional nursing home setting may be the close monitoring and control of the healthcare professionals who work with residents. Too often the news reports include stories of home health operations failing their residents and failing the system. There are cases of negligent care and abuse of home health residents as well as cases of fraud and financial deceit. When individuals are tempted by the chance to get a little extra from the government, that little extra tends to become more. Many caught in home health fraud schemes are able to take significant amounts of money before they are stopped. How would you know your loved one was cared for by individuals engaging in home health fraud? What questions about the quality of care would keep you up at night?

Is there a way to know whether home health care givers are honest and trustworthy?

When choosing in home healthcare options, it is important to do your research and conduct due diligence by investigating the backgrounds of the individuals who may be caring for you or your loved one. For less than 100 dollars you can obtain background investigative reports for home health professionals. Professional licenses can be verified and in the process, any reports of discipline of that professional may be available. If you are not comfortable or particularly skilled at online investigation, our law firm can assist you or recommend another who may be better able to help you in the vetting process. Unfortunately, it may be difficult to tell whether the individual of any character is engaged in or connected to a fraudulent operation.

Medicare billing fraud cases are reported frequently and investigations lead to convictions.

When people picture Medicare fraud, the image may be a dark basement with leaking pipes and a crooked looking person working at a desk with a sinister look and laugh. In reality, the setting may be right outside your window or down the street. The suburban landscape is ripe with reports of home health fraud. In Schaumburg, Illinois, a 47 year-old woman was convicted on 21 counts of fraud and making false statements; and sentenced to 72 months, with an order to pay 15.6 million dollars in restitution. “Home-health fraud has become a significant problem nationally and particularly in the Chicago area,” Assistant U.S. Attorney Stephen Chahn Lee argued in the government’s sentencing memorandum. “Such fraud cannot happen without people like the defendant, who abuse Medicare’s rules and abuse the trust placed in them by Medicare and their patients.[i]

Examples of Medicare billing fraud.

In this recent fraud case in Schaumburg, the woman leading the fraud directed her employees to conduct in-home visits for patients who did not need care, people who were not home-bound and quite able and otherwise healthy. When the employees billed Medicare for the visits, they billed for the more expensive and complicated levels of care, even though no care was needed or often performed. The inflated billing and billing for services not needed is an easy fraud to hide if nobody is looking.

Billing Medicare for services not actually needed or performed is such big business that some fraud operations offer kickbacks to individuals who recruit and sign up new home health patients, regardless of their health condition, so long as they qualify for Medicare services and a bill for something can be generated.

How do the frauds become exposed, investigated and stopped if nobody is looking?

Whistleblowers lead to investigations and convictions for home health fraud where Medicare is duped into paying for services never needed or rendered. If one of the nurses working for the woman leading up the Schaumburg fraud scheme was the whistleblower and reported the fraud to authorities, that person would be paid a part of the restitution ordered, in this case that would be a cut of the more than 15-million-dollar restitution.

If you or someone you know suspects others are profiting from home health fraud, you can contact our law firm by dialing 773-631-4580 to learn about your rights under the law and whether you may be able to stop a home health operation engaging in fraudulent practices.

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] eNews Park Forest, Head of Schaumburg Home Health Company Sentenced to Six Years for Scheming to Fraudulently Bill Medicare for Unnecessary Care, Chicago ENEWSPF, July 26, 2016.

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Chicago investment fund manager Neal V. Goyal charged with fraud by SEC and U.S. Attorneys

It is very important to research and conduct due diligence before investing money with fund managers who look, walk and talk the part but who might be a wolf in sheep’s clothing.

It is very important to research and conduct due diligence before investing money with fund managers who look, walk and talk the part but who might be a wolf in sheep’s clothing.

The Securities Exchange Commission (“SEC”) charged Chicago investment fund manager, Neal V. Goyal, for the Ponzi scheme in which he used investor monies to purchase himself houses and businesses for him and his wife. SEC fraud charges also named Blue Horizon Asset Management and Caldera Advisors, Goyal’s firms. The U.S. Attorney’s Office for the Northern District of Illinois is also prosecuting Goyal. In a common course of action the judge in a federal district court ordered Goyal and his business assets frozen pending investigation and prosecution of criminal charges.

The SEC complaint states that at least 35 people invested in Goyal’s funds. He told investors their money was invested in equities and were “significantly outperformed the market.” The complaint stated that Goyal “never invested the vast majority of the money he raised from investors, and the limited trading that Goyal did perform was unsuccessful and resulted in significant losses.” You would imagine the clients would have been alarmed at the losses but they never knew because Goyal sent them false statements that made it look like the investors were making money. In a “Ponzi-scheme fashion, by using later investors’ money to meet the distribution requests of prior investors,” Goyal was able to keep clients happy while skimming the cash flow to fund his lavish lifestyle, to pay expenses and support personal businesses including, “a bar and two children’s clothing boutiques that his wife operates in Chicago.”

Many of the people who engage in fraud schemes gain the trust of respected members of the communities where they live and work. Since they spend money like successful fund managers, most people do not assume any wrongdoing or fraud until there are signs that money is missing. Building trust and friendship with investors also helps insulate the schemers from suspicion.

“From the beginning of his scheme, Goyal lied to investors and created fake account statements portraying positive trading returns in order to gain their trust and attract additional investments,” said David Glockner, director of the SEC’s Chicago Regional Office.  “Goyal’s limited trading was unsuccessful, and he stole the vast majority of the money he raised.” Read more in the SEC Press Release dated May 29, 2014.

The SEC’s complaint against Goyal and the two advising companies he owned and controlled, charges them with violations of anti-fraud provisions of the Securities Act of 1933, Securities Exchange Act of 1934 and Rule 10b-5, and Investment Advisers Act of 1940. Judge Rebecca R. Pallmeyer ordered a freeze of Goyal’s assets and accounts as a preliminary measure to preserve what assets if any remain that could be recaptured to reimburse defrauded investors.

As there are updates in this case we will report on them to you. Our law firm represents victims of financial fraud and we work to increase awareness of fraudulent activity and highlight the types of crimes. It is very important to research and conduct due diligence before investing money with fund managers who look, walk and talk the part but who might be a wolf in sheep’s clothing.

If you are interested in learning more about Michael V. Favia & Associates, serving Chicago and its suburban communities, please visit the Favia Law Firm website for resources and articles of interest. To contact the firm to speak to a lawyer about a healthcare-related concern, you may dial (773) 631-4580. For more information about the firm’s practice areas, you can also visit the firm’s Facebook and Twitter sites. Please “LIke” and “Follow” respectively to keep in touch!

15-year sentence for client fraud: Former N.J. broker stole $9.8M from clients

IDFPR: "Unfortunately, some unscrupulous promoters abuse our freedom to choose by concocting investment schemes that have zero possibility of making money for anyone other than themselves. Such persons promise investment rewards they cannot possibly deliver and have no intention of delivering."

IDFPR: “Unfortunately, some unscrupulous promoters abuse our freedom to choose by concocting investment schemes that have zero possibility of making money for anyone other than themselves. Such persons promise investment rewards they cannot possibly deliver and have no intention of delivering.”

A lifetime of savings – gone! What would you do if your elderly parent told you their investments and retirement money were wiped out in a Ponzi scheme? Clients of former New Jersey investment broker, Maxwell B. Smith III, likely received a phone call from a parent or friend who fell victim to fraud. The article published in the Financial Advisor publication states that, “Smith operated a Ponzi scheme for 17 years, victimizing a dozen elderly clients through several bank accounts he controlled…[i]

“ I handled a case like this a few years ago.  These types of cases are very depressing for everyone involved.” Attorney Michael V. Favia

Smith’s pitch to clients was an investment in health-care facilities. The money wasn’t invested as promised, rather it was spent on Smith’s personal expenses, “…including yearly trips to Gordes, France, for several weeks each summer, according to the attorney general…” the Financial Advisor article states. Smith was sentenced this June to seven years in federal prison after he pled guilty to charges of mail fraud, a common charge in cases like this.

The New Jersey Bureau of Securities also stepped in and pulled Smith’s license to work in the securities industry in New Jersey, for life.  

Could or should the victims have suspected fraud? It is tough to know whether the person you trust with your investments is going to swindle you. Many finance professionals hang their own shingle later in their career and their appearance and marketing materials often look like what anyone might expect from someone like the defendant in this case. In most financial fraud cases, the investors receive periodic payments, on time, as the fraudulent investor uses new investor money to pay dividends to existing clients, and nobody raises an eyebrow until it is too late and the money is gone.

Like New Jersey, Illinois state agencies investigate suggestions of fraud on a regular basis. The Illinois Department of Financial and Professional Regulations (“IDFPR”) offers tips on investment swindles on their website.[ii] Learn more about the multi-billion dollar business of investment fraud and how the swindlers approach their victims. Read about the techniques used and what should be a red flag that things are too good to be true. You might feel safer investing with well-known investment company but be advised; even a large firm can have bad actors within.

If you suspect fraud, the Law Firm of Michael V. Favia can help!

If you suspect an investment professional is up to no good, you can contact the IDFPR for help. If you want more information about how the IDFPR works and what you can do if you suspect fraud, attorney Michael V. Favia practices professional licensing and regulation law. To learn more about how to do some research before hiring an independent investment advisor please use this website link to contact Michael V. Faiva. For more information on similar matters you can Like the firm’s Facebook page and Follow on Twitter. You may also subscribe to the firm’s monthly newsletter by clicking here.


[ii] Illinois Department of Financial & Professional Regulations: Investment Swindles – How They Work and How to Avoid Them.