Tag Archives: Illinois Medical License

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

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Home health care fraud in Bloomingdale, bogus certifications lead to jail time

home health care fraud

Image courtesy of Chicago Sun-Times, Bloomingdale doctor gets two years for Medicare fraud http://bit.ly/1J7HUWX

Home health care facilities can be hotbeds for fraud and prosecutors with their investigators recently put another fraud case in the news. The Bloomingdale-based Home Care Physicians Inc., part-owner and employee, Dr. Arthur Davida, 62, pleaded guilty and received a 2-year sentence in connection with home health care fraud. Physicians engaging in fraudulent activities are not only subject to criminal and civil penalties, they also face discipline by the Illinois Medical Board as well as licensing agencies in any other state in which they are now or in the future wish to practice medicine. While it may be possible to rehabilitate a the career of a convicted physician, it would certainly be an uphill battle.

The increase in popularity of home health care facilities can cause concern for many.

In recent years, home health care has become a well-known and more affordable alternative to traditional nursing and care facilities. Concerns about care and the well-being of their loved ones in nursing facilities make it an easier choice for many families to engage the services of cost-effective home health care operations so their loved ones can stay in their own homes or reside in a home health care residence with one or two other individuals in need of care. Unfortunately, the concerns for proper care and attention are present in home health care situations, just as they are in traditional nursing care facilities. Through increased awareness of the risks and problems in home health care, more family members become aware of situations in which their loved ones could be used as pawns in a fraudulent operation.

In this case, the suburban doctor was alleged to be part of a fraud scheme in with home health agencies who provided patient referrals in exchange for certifications that the patients were confined to homes and not physically or mentally fit to come and go on their own volition. During the course of the investigation by the Medicare Fraud Strike Force, prosecutors from the office of the U.S. Attorney General and the Fraud Section of the U.S. Department of Justice, it was determined that 20 percent of the patients were not confined to their homes. The home health agencies relied on the doctor’s certification that the patients were homebound so that the agencies could bill Medicare for home health care and treatment that those 20 percent of patients did not need. Additionally, the investigation uncovered evidence of billing for unnecessary medical treatments.

Investigators and prosecutors are vigilant in identifying and stopping Medicare fraud.

The cost to Medicare and taxpayers in this case alone totaled at least $4 million according to prosecutors in this case. Imposing the 2 year sentence, U.S. District Court Judge John Tharp, Jr. said this crime is a “very serious offense” involving “stealing money” from Medicare.[i]

The Medicare Fraud Strike Force, overseen by the U.S. Department of Health & Human Services, Officer of Inspector General, established in 2007, combines efforts of the Office of Inspector General, the U.S. Department of Justice, U.S. Attorneys offices, the FBI, private investigators and local law enforcement. Teams of professionals review data and intelligence to identify and stop individuals abusing the Medicare system, bringing them to justice.

This case is relatively recent and as of the date of this blog article, Dr. Arthur Davida is still listed as having a valid medical license in the State of Illinois. Anyone can search for a physician profile on the website of the Illinois Department of Financial and Professional Regulation (IDFPR). A conviction of a crime routinely causes an investigation of a licensed professional, and the due process of law takes considerable time. It is unknown what will happen to this physician’s license to practice medicine in Illinois and other states. According to prosecutors, in his plea agreement the doctor in this case acquiesced to providing the fraudulent certifications for fear the agencies would stop sending referrals.[ii] Cooperation with authorities and prosecutors can make a difference not only in sentencing but in also concerning a professional license.

Chicago health law and litigation attorney, Michael V. Favia, represents Illinois physicians.

Michael V. Favia has a career in law working as a prosecutor and a defender in health care law and litigation. In addition, Favia’s past and current work with the IDFPR touches every element of this case and a variety of fraud-based cases involving Medicare billing for health care services. To learn more about attorney Favia, you may review his professional profile.

Michael V. Favia & Associates are available to advise and represent physicians 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 visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

 

[i] Chicago SunTimes, Bloomingdale doctor gets two years for Medicare fraud, by Sun-Times Wire, Jan 7, 2016.

[ii] See HNi above.

State licensing issues affecting telemedicine practice among several states

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Historically, state licensing boards and organizations require health care professionals to become independently licensed by each state in which they chose to practice medicine.[i] Surely, there are metropolitan areas in our nation where several states make up a metropolitan area, particularly on the East Coast. The Chicago metropolitan area spans across state lines to include residents of Wisconsin, Illinois and Indiana, and notably, Michigan is not too far from the Chicago area and many people keep weekend lake homes there. Consider an oncologist who manages care and treatment of cancer patients, who has a lake house in New Buffalo, Michigan and a practice based in Chicago. What happens when telemedicine allows the doctor to use technology to monitor Chicago patients from his lake house in Michigan?

As technology and telemedicine offer health care professionals new options, there are new questions arising in professional licensing among the states.

Telemedicine is the use of mobile technology to perform certain routine health care services. Common applications of telemedicine include a physician with rural patients who require services that could be performed through the use of mobile technology, saving the patients the time and expense of travel to the doctor’s main office. Telemedicine also reduces the use of the office space and staff when patients are seeing the doctor from home.

Latoya Thomas, director of the State Policy Resource Center for the American Telemedicine Association commented in a recent article about the increased frequency in which states and organizations are addressing the concerns raised about the practice of telemedicine and developing appropriate laws and policies. Thomas stated, “It is something I think hospitals across the country are becoming familiar with if they haven’t already,” Thomas says, “and trying to figure out how they can comply with current standards but also prepare themselves for any new policies that might come down the pike in 2016.”

There are some “safe harbor” rules for telemedicine and states adopting policies and procedures for mobile healthcare practice.

In another scenario, an out of state patient who sees a physician in Illinois, for example, can conduct a surgical follow-up visit online; Indiana, Illinois and Ohio permit online physician follow-up with established patients[ii]. Another instance of allowed interstate telemedical practice not requiring the physician be licensed in the outlying state is the safe harbor rule of infrequent patient treatment. Minnesota has a telemedicine statute stating, “An out-of-state physician who holds a valid license to practice medicine in another state need not possess a Minnesota license-nor even register with the Minnesota Board-if she provides telemedicine services on an “irregular or infrequent basis,” which is defined as less than once per month or to fewer than ten patients annually.[iii]

There is not a uniform law directing the standard of interstate telemedical practice yet. There are Telemedicine Practice Guidelines, however, offered by the American Telemedicine Association. Some states do allow physicians in neighboring or other states to practice medicine in their state without being independently licensed, but where the out of state physician practices with the same standard of care required in the individual state.

Before engaging in telemedicine, it is important to seek advice and counsel to avoid unauthorized practice of medicine liability.

Michael V. Favia and his associates and colleagues in health care law and litigation actively follow updates in mobile health care technology and the delivery of health care services. Favia works with clients not only with matters involving the practice of medicine directly, but also with the state licensing and regulation of health care professionals. When considering telemedicine, it is important to consult with the malpractice insurance provider and find out what policies control the location of the delivery of health care services.

Michael V. Favia & Associates are available to assist nurses and healthcare professionals with professional licensing 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’ 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] Healthcare Dive, State licensure issues challenging telemedicine borders, by Heather Caspi, Oct. 29, 2015

[ii] The National Law Review, The Out-of-State Practice of Telemedicine: Licensure Challenges and Opportunities, Oct. 21, 2015

[iii] See HNi above

About the Illinois Professional Licensing Consultants and Attorneys

Illinois Professional Licensing Consultants 6Attorney Michael V. Favia, founder and CEO of the Illinois Professional Licensing Consultants, is a former Chief of Prosecution for the Illinois Department of Regulation (IDPR – now IDFPR). Favia’s 20 plus years of professional licensing experience, working on the not only the investigation and prosecution but also as defense counsel in professional licensing matters, made him a go-to attorney in the Chicago area and beyond. With such extensive experience and a proprietary list of colleagues and consultants at his fingertips, law firms frequently retain Favia and his team to assist with their representation of professional licensing clients.

Many attorneys consult with Michael V. Favia and his professional licensing consultant team is because they gain the advantage of working with Favia and the others who worked with the State of Illinois and with the Department of Professional Regulation. While the Department experiences changes in staff and some policies and procedures, the general nature of the Department’s responsibilities and modus operandi remains constant.

The Illinois Department of Financial and Professional Regulation (IDFPR) mission is “to utilize responsive, innovative, transparent, and efficient (R.I.T.E.) governance to create an ideal regulatory environment that (1) allows economic growth to flourish, and (2) effectively optimizes consumer choice.[i]

IDFPRThe Department’s responsibility is to regulate and oversee the professional licenses to ensure the people of the State of Illinois receive quality services from licensed providers. When a complaint about a licensee is filed with the Department, or the Department otherwise learns of sub-standard conduct or wrongdoing, they have a duty to investigate and discipline licensees when appropriate. The role of a licensing consultant and attorney is to ensure the procedures are properly followed and allow the licensee to present their best information to the Department, to ensure a fair process. When the licensing consultant is intimately familiar with the Department and its policies and procedures, that attorney representing the licensee can help guide them through the process to their benefit.

Not only do the Illinois Professional Licensing Consultants work with licensees, they also work directly with health care provider organizations and societies on issues including their licensed professionals, hospital privileges, and how to improve policies and procedures in health care to ensure the best in service is given to the people of the State of Illinois.

Illinois Professional Licensing Consultants 5Clients who consult with the Illinois Professional Licensing Consultants may be new applicants for licensure, individuals with complaints, and others seeking to restore their license after a period of suspension or revocation.

Michael V. Favia & Associates and the team of Illinois Professional Licensing Consultants have 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 the Illinois Professional Licensing Consultants and their work, please visit www.il-licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

 

[i] Illinois Department of Financial and Professional Regulation, About IDFPR, Agency Mission.

Illinois Physician Licensing of International Medical Graduates and Domestic Applicants

The Illinois Professional Licensing Consultants and the law firm of Michael V. Favia & Associates assist international and domestic physicians and first-time applicants for Licensure in the State of Illinois.

The Illinois Professional Licensing Consultants and the law firm of Michael V. Favia & Associates assist international and domestic physicians and first-time applicants for Licensure in the State of Illinois.

The State of Illinois is offers world-class opportunities for physicians wishing to advance their medical practice career. Individuals seeking to become an Illinois physician may come from domestic and foreign medical schools, the later collectively referred to as international medical graduates (“IMGs”). The Illinois Department of Financial and Professional Regulation (IDFPR) and the Illinois Medical Licensing Board regulate medical Doctors in Illinois. Admission to the practice of medicine in Illinois requires an applicant meet eligibility criteria, testing mandates and credentials required not only on the state but also first on a national level. Professional licensing consultants and attorneys assist applicants with the process of becoming an Illinois-licensed physician.

International Medical Graduates can attain successful careers as Illinois doctors when they are committed to high standards of excellence in medicine.

“The American Medical Association reports that there are 22,230 IMG resident physicians,” and the State of Illinois is 5th in the nation for its number of post-residency IMGs, totaling 13,439 (34 percent of Illinois doctors are internationally educated)[i].

Prior to examination and application for Illinois licensing, an IMG must first obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG) and complete a first-year in a resident program. The ECFMG certification requires the applicant pass the first two stages of the U.S. Medical Licensure Examination (USMLE).

Upon completion of the national certifications, an IMG may apply for an Illinois license to practice medicine by completing one of the applicable processes[ii]:

  1. Endorsement: Physicians licensed in another U.S. state may apply for an Illinois medical license by endorsement of the other state license, provided the applicant also meet specific Illinois requirements applicable to the individual applicant; or
  2. Acceptance of Examination: First-time physician applicants may register to complete the Illinois medical license exam, after completing the first year of medical residency. The individual must receiving passing scores on Step 3 of the USMLE. Note: The applicant must complete 24 (twenty-four) months of graduate medical education.

The IDFPR requires that applicants for Illinois medical licenses are of good moral character, meet experience, examination and educational requirements and report their U.S. social security number. Physician applicants are also required to pay state fees. The application process requiring a personal history report, credential verification, criminal background check and additional details is available on the IDFPR website[iii].

IMG and domestic graduates are advised to seek the advice and assistance of an attorney skilled in the processes and procedures of Illinois licensing, who are able to identify and guide a physician through the process.

The Illinois Professional Licensing Consultants and the law firm of Michael V. Favia & Associates assist international and domestic physicians and first-time applicants for Licensure in the State of Illinois.

Michael V. Favia & Associates and the Illinois Professional Licensing Consultants, of whom Michael V. Favia is a primary attorney, are available to assist Illinois medical license applicants and connected matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, an attorney will be able to assist at your convenience and discretion. For more about Michael V. Favia & Associates and their 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] Upwardlyglobal.com, Skilled Immigrant Job Seekers, Illinois Physician (MD) Professional Licensing Guide.

[ii] See HNi above.

[iii] IDFPR Instruction Sheet, Physician – Licensure by Acceptance of Examination; Physician – Licensure by Endorsement.