Tag Archives: Kickbacks

PODCAST: Criminal Healthcare Fraud and Defense with Attorney Anthony Schumann

This podcast interview with Anthony Schumann focuses on current trends and topics in the area of criminal healthcare fraud and defense. In the next 30 minutes we will cover everything from how to be proactive in your practice and limit your liability, to what steps to take if you are audited, investigated or charged with a crime.

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Topics covered in this 30-minute interview 

  • Introducing Anthony Schumann, tell us about your law practice
  • Sources of criminal healthcare law, state and federal
  • Enforcement areas: home health, kickbacks, mental health, drug diversion, etc.
  • What to expect during investigations and when to obtain legal defense counsel
  • Professional licensing concerns in connection with dispositions of cases
  • What to expect in defending criminal healthcare fraud charges

Anthony L. Schumann is a partner in the Chicago office of Quintairos, Prieto, Wood & Boyer, P.A.  For more than 30 years, Mr. Schumann has participated in over 150 civil and criminal trials and evidentiary hearings.  He focuses his practice in the areas of commercial litigation, employment law, government liability, and white collar criminal defense.  He has extensive experience representing corporate, governmental and individual clients in state and federal courts and during all stages of investigation and throughout the litigation process.  Mr. Schumann has extensive experience assisting companies with internal investigations and in handling compliance issues.  He has attained an AV® rating from Martindale-Hubbell Law Directory, the highest professional rating awarded for legal ability and ethical standards; and he is also included in the listings of Illinois Leading Lawyer and Illinois Super Lawyer.

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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.

Be proactive and avoid exposure to home healthcare fraud investigations and convictions

Kickbacks to employees and marketers for patient referrals is a common problem and area of abuse in home healthcare. There are many more activities the experts in law enforcement study in an effort to isolate fraud.

Kickbacks to employees and marketers for patient referrals is a common problem and area of abuse in home healthcare. There are many more activities the experts in law enforcement study in an effort to isolate fraud.

The rising cost of healthcare and nursing facilities caused an increase in the popularity of home healthcare facilities, where disabled and elderly patients can receive appropriate levels of care. While many people benefit from the home healthcare option, many may also find ways to defraud the system. Billions of dollars a year lost to home healthcare fraud lead to increased healthcare costs and insurance premiums. From federal investigations and search warrants served on residential facilities where fraud is suspected, to the investigations of the Medicare Fraud Strike Force, there are increasing news stories involving fraud and the measures necessary to prevent and stop abuse of the system.

The FBI released a recent home healthcare fraud story:

“The husband-and-wife owners of a Chicago home-healthcare business paid kickbacks to employees and marketers in exchange for referring elderly and disabled patients to the company for unnecessary or non-existent treatment that was funded by Medicare, according to a 23-count federal indictment unsealed today.[i]

Kickbacks to employees and marketers for patient referrals is a common problem and area of abuse in home healthcare. There are many more activities the experts in law enforcement study in an effort to isolate fraud. Since whistle blowers are able to share in the criminal penalties received in some fraud cases, there could be more eyes on home healthcare operations, including friends and neighbors who hear stories about home healthcare fraud. In some instances, honest and legitimate home healthcare providers could be reported to authorities. Defending against charges of fraud can involve documentation, effort and legal representation.

Common examples of home healthcare fraud are both due to knowing wrongdoing and negligence.

  • Billing and Claims Fraud: Sending a reimbursement claim to Medicare for services never received, exaggerated patient conditions, unnecessary services and false timesheets for healthcare providers are common billing and claims fraud activities. It is important to keep accurate and correct records of everything. Home healthcare workers should always ask whether they would be able to back up all their billing and claim submissions.
  • Fraudulent Accounting: When home healthcare operations cut corners in accounting and bookkeeping, their activity could look like an effort to avoid tax liabilities or earn more credits than actually earned. It is a good idea to keep an extra backup of all accounting and obtaining a C.P.A. review and audit is a smart and proactive measure.
  • Elder and At Risk Patient Abuse: The family of home healthcare patients are frequently notified by news stories about elder abuse that even their loved one may be at risk. It is vitally important to document any injuries to a patient, even if they bump into a wall and bruise an arm. Home healthcare workers may earn lower wages, have minimal training, and experience high turnover, so it is important for managers of home healthcare operations to be present and knowledgeable about everything going on in their facility.
  • Background Check Fraud: Where background checks are required by Medicare, for example, an industry-standard or specifically identified process must be used to verify the criminal and healthcare background of home healthcare workers. Cutting corners and missing a past felony in a state one did not think to check could lead to worse problems. Home healthcare managers attempting to avoid liability for negligence should always perform and document the best reasonable industry required background check.
  • Patient Recruitment Kickbacks: Paying employees and contractors to solicit patients is not allowed by the Medicare system and any home healthcare worker pulling homeless people off the street or placing individuals in home healthcare who do not legitimately need that level of care are likely to be convicted of fraud if investigated and caught. Avoiding even the slight appearance of impropriety is important. Proper paperwork used in admitting new home healthcare patients should be adopted as a diligence practice.
  • Home Healthcare and Physician Conspirators: When a doctor conspires with a home healthcare operation to write prescriptions, assist with certifications and other operating documentation, everyone involved is exposed to civil and criminal liability. If a doctor is engaged with wrongdoing with another you otherwise do not know, expect the investigators to scrutinize anyone else that doctor has worked with. Being proactive and documenting research on doctors with whom home healthcare operators transact, is an important precaution.

The best way to avoid unnecessary headaches and suspicions or investigations of wrongdoing is to keep all policies and practices well documented and reviewed by appropriate professionals. Michael V. Favia & Associates work with home healthcare operations to make sure they comply with the law and avoid exposure to liability for wrongdoing.

Michael V. Favia & Associates’ offices are 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] FBI press releases, Owners and Nurses of Chicago Home Health Care Company Among Seven Indicted in Medicare Fraud and Kickback Scheme, Aug. 27, 2015.

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.