Tag Archives: Healthcare Fraud

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.

 

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Chicago doctor charged in cash kickback for Medicare and Medicaid patient referrals

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.

A Chicago doctor was recently charged in a kick back case. Medicare and Medicaid patients can be valuable to individuals looking to make money from sending referrals to doctors and hospitals in exchange for kickbacks. There are several layers of the health care industry from patient consultants and group service providers to the doctors and administration at small and large patient care facilities. The separation among health care service industry workers should prevent wrongdoing. In this recent case, a doctor directly offered a number of valuable patients in exchange for a cash kickback from the provider.

A doctor from suburban Lemont, Illinois, was charged with illegal remunerations.

Dr. Neil Sharma, 34, worked as the medical director of an Illinois healthcare company that worked as a managed care organization in the Illinois Integrated Care Program. The company has contracts with Medicare and Medicaid and made patient referrals to doctors and service providers for patients enrolled with the company. The doctors and service providers bill the Medicaid beneficiaries when they treat the referred patients, many of whom are elderly and require ongoing care and services.

According to the complaint, as reported in recent news[i], Dr. Sharma is accused of receiving a $2,500 cash kickback from an individual provider in exchange for guaranteed patient referrals. The plan had been cash payments every month for the referrals.

If found guilty of the charge of illegal remunerations, Dr. Sharma could receive a sentence of up to five years in prison and face fines up to $25,000.

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

The Illinois Department of Financial and Professional Responsibility (“IDFPR”) maintains a website where the public can look up the status of a professional’s license to practice in Illinois. Dr. Sharma is listed on the site as of the date of this article as having an active license and board certified in the area of geriatric patient care and family medicine.

When the IDFPR receives notice of an alleged violation of law, often directly from the charging authority, an investigation may take place to review the allegations and result of the legal process before making a recommendation. The Department can take no action, censure a professional or seek suspension or revocation through administrative prosecution.

What evidence occurs in the underlying case might have different weight with the IDFPR despite the treatment of that evidence in a civil or criminal court. For example, a small infraction of law with minor outcome, such as payment of forfeiture, can lead to greater concerns for the professional’s license and ability to earn a living in the event there is a history of inquiries and discipline. A professional licensing attorney can help advise and represent professionals facing licensing inquiries and charges.

About our firm:

Michael V. Favia & Associates are available to assist with analysis and advice on a difficult IDFPR matter. 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’ 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 Tribune, Lemont doctor accused of taking kickback, Mar. 13, 2015.

False Claims Act lawsuits and the whistleblowers who share in recoveries

2013 was a strong year for the U.S. Department of Justice, recovering $3.8 billion in fraud cases.

2013 was a strong year for the U.S. Department of Justice, recovering $3.8 billion in fraud cases.

The False Claims Act[i] is the federal law used to prosecute those who make fraudulent claims for payment through government programs. The majority of false claims are made by government contractors engaged in work connected with government spending programs such as health care and military programs. Also referred to as the “Lincoln Law” the False Claims Act is known for its whistleblower provisions. A private citizen may file lawsuits on behalf of the government when the person or entity improperly receives or avoids making payment to the government. An example is knowingly submitting false claims for payment. Submitting false records to back up a bogus claim is another typical violation of the Act.

Whistleblowers are rewarded by a percentage of the amount recovered in a successful lawsuit.

“Qui tam[ii]” laws allow citizens to sue on behalf of governments and be paid a percentage of the recovery, often in the range of 15 to 25%. There was a case in Illinois involving Medicaid processing fraud. The downstate town of Energy, Illinois was in the national news when a doctor plead guilty for various charges in connection with his three clinics. Click/tap here to read the FBI press release, “Doctor from Energy, Illinois Pleads Guilty to Charges of Obstruction of Justice, Tampering with a Witness, and Illegal Dispensation of Methadone Doctor’s Three Corporations Plead to Charges of Conspiracy and Healthcare Fraud.” In 1989, the Whistleblower Protection Act[iii] became law and offered protection to private individuals who report misconduct. The whistleblower is safe from retaliatory action by the accused person(s) and organization(s). With this protection and the qui tam laws, the people who report wrongdoing are rewarded for their effort in saving American taxpayers from fraud.

2013 was a strong year for the U.S. Department of Justice, recovering $3.8 billion in fraud cases.

Plaintiff’s attorneys representing qui tam litigants filed civil lawsuits resulting in judgments to recover the $3.8 billion, the largest amount on record, second only to the 2012 recoveries totaling close to $5 billion. ““It has been another banner year for civil fraud recoveries, but more importantly, it has been a great year for the taxpayer and for the millions of Americans, state agencies and organizations that benefit from government programs and contracts,” said Assistant Attorney General Delery.[iv]” If you consider the rewards to whistleblowers, at a conservative rate of 20%, would total $760 million in shared recoveries. The DOJ press release states that the government’s success in prosecuting False Claim Act cases is a strong deterrent to anyone who might consider misappropriating public funds.

Would you blow the whistle if you discovered you had personal knowledge of frauds being perpetrated on the U.S. government? Fraudulent claims activity might not be immediately apparent. Sometimes things just do not seem right. What if you file a lawsuit and you are wrong? Whistleblower protections are not conditioned upon a successful lawsuit and if an investigation turns up no wrongdoing, the whistleblower who acted in good faith will be protected against retaliation. If you or someone you know believes frauds are being committed then it is best to contact a lawyer who is experienced in False Claims Act cases and who will be able to advise and represent the whistleblower client.

Michael V. Favia is experienced in complex litigation involving government contract and similar types of fraud. Mr. Favia’s extensive health care law and litigation career allows him and a skilled group of associate colleagues the benefit of experience in representing clients with qui tam claims for violations of the False Claim Act. Michael V. Favia & Associates are available to help and meet for client consultations with offices conveniently located in the Chicago Loop, Northwest side and suburbs so 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.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.


[i] U.S. Department of Justice publication: The False Claims Act: A Primer

[ii] Law.com legal dictionary: qui tam action.

[iii] CRS Report for Congress: The Whistleblower Protection Act: An Overview. Mar. 12, 2007.

[iv] U.S. Department of Justice: Justice Department Recovers $3.8 Billion from False Claims Act Cases in Fiscal Year 2013. Press release, Dec. 20, 2013.