Tag Archives: Michael V Favia and Associates

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.

 

PODCAST: Appealing adverse final rulings in healthcare discipline, discharge and termination

Today’s podcast interview with attorney Michael Cohen, focuses on his work with attorney Michael Favia in defending healthcare professionals and appealing adverse decisions from any state agency final ruling affecting involving discipline, discharge and terminations. There are many compelling reasons to file an appeal of a ruling affecting your healthcare career. Attorneys Cohen and Favia work as a team to fight for the professional being disciplined or terminated. USE THIS LINK TO LISTEN ANYTIME

Topics covered in this 30-minute interview:

  • Common elements in reportable healthcare discipline, discharge and termination cases;
  • Describing usual procedural processes leading to an appealable final ruling and decision;
  • The measurable impact of healthcare discipline or termination on a local and national level;
  • What to expect in appealing an adverse discipline, discharge or termination ruling.

Michael B. Cohen is a partner in the Chicago office of Quintairos, Prieto, Wood & Boyer, P.A. Mr. Cohen represents clients in a wide variety of civil and criminal litigation matters, both state and federal at the trial and appellate levels, focused on complex commercial litigation. His litigation practice includes the areas of appellate law, bankruptcy, civil rights, commercial, constitutional, criminal, employment, estates and trusts, insurance coverage, medical malpractice defense, personal injury actions, privacy, professional liability, and real estate.

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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.

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

Medicare fraud bust in Illinois leads to 6 and ½ year sentence

The biggest problem facing Medicare fraud might be the arrogance of people who get away with bad acts for too long. Meanwhile, with the cooperation of law enforcement agencies using technology and skill, fraud schemes are frequently shut down and bad actors are prosecuted. In some cases, someone on the inside is the whistleblower who notifies authorities. In this case, the nurses who challenged fraudulent behavior were treated poorly and terminated. Several former employees filed whistleblower lawsuits leading to the investigation, arrest and prosecutions in this major Medicare fraud case.

The $90 million Medicare fraud scheme

In this case, Seth Gillman, Chicago businessman and mastermind of this fraud scheme exploited terminally ill patients in Illinois in the $20 million Medicare fraud. Gillman was convicted and sentenced to 6 ½ years in federal prison.

The Chicago Tribune reports, “By paying kickbacks to nursing homes and giving bonuses to employees who took part in the fraud, Gillman built his Passages Hospice LLC into the largest such company in Illinois, serving terminally ill patients in 89 countries and billing Medicare more than $90 million from 2008-2012, government records show.[i]

Unfortunately, Passages Hospice did not provide the care consistent with what Medicare paid in claims submitted for patient services. Meanwhile, Gillman lived a lavish lifestyle, excessive even for a licensed attorney and nursing home administrator. To the U.S. District Court Judge, Gillman stated, “I betrayed the trust of Medicare and I besmirched the integrity of hospice all together…I was stupid and I was wrong.[ii]

Investigation and discovery of Medicare fraud schemes

Why would anyone want to be the whistleblower? When an individual with “clean hands” contacts and works with the investigation of Medicare fraud schemes, they may be removing themselves from the eye of the investigators. Since many of the common Medicare fraud schemes are complex, there are multiple people involved. Therefore, investigators might be looking at everyone involved in a healthcare operation, when there is a suggestion of wrongdoing. It may be easier to report the fraud than be accused of being a part of it or helping with a cover-up.

Another reason people report fraud is they may be able to recover a percentage of fines assessed and paid in connection with the Medicare fraud prosecution.  This is called Qui Tam and our article on point explains the process. See Dr. Whistleblower: Reporting $10 million in a Medicare billing fraud scheme, could share in recovery.

If you or another suspect there may be wrongdoing occurring in a health-related practice or care facility, it is a good idea to talk to a health law and litigation lawyer to figure out where you may stand in the event there is a current or pending investigation. You might also be a proper person to file a whistleblower lawsuit. You might also be an individual responsible for others below you who you believe may be engaged in wrongdoing. Likewise, it is imperative to secure experienced legal counsel.

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.

 

[i] Chicago Tribune, Hospice CEO gets 6 ½ years for fraud scheme, by David Jackson and Gary Marx, Mar. 7, 2017.

[ii] See HNi above.

Facing challenges in documenting medical care

Every healthcare professional knows that, at some point in their medical practice, they may be called on to defend patient care. When time passes and our ability to accurately recall information is diminished we should be able to rely on documentation of events to answer questions. There are practices you can adopt that can make it easier to make a good habit of properly documenting everything that happens before, during and after patient care.

Documenting everything is not the only key component to keeping proper records. Your medical record entries must be adequate representations of what happened. Imagine a jury reviewing records in a medical malpractice case, assume they do not spend much of their time reading medical records. How might they react to inadequate records? What may be obvious to you may not be to them. When others are charged with judging your credibility, the quality of your medical records can either enhance or diminish your credibility.

Examples of detrimental documentation practices, as identified in the recently article published by The Doctors Company, The Faintest Ink.[i]

  • Gaps and delays in documentation
  • Illegible entries
  • Dictation with blanks
  • Unflattering or judgmental patient descriptions
  • Entries appearing to vent negative feelings
  • Altered records and records missing documents or entries

To ensure proper documentation, each time and every time, the best practice is to develop a system for entering and recording information. Almost like a checklist, you can determine the rules and procedures for managing information. Identify details regarding when, where, how, what and why information is recorded. While it may seem like extra work, at some point your medical records could be under review and read in isolation of other information. Therefore, every single time it is helpful to identify why an entry is being recorded.

Features and benefits of good documentation habits

Increased communication with patients and increased continuity of care should increase understanding, decrease misunderstanding. In many medical malpractice cases, the root of the problem leading to a complaint can often be identified as failure in the communication process.

One way to improve communication is to use dictation equipment to make your patient notes. When you dictate notes right in front of patients you are more likely to read the details into the notes so that the patient can understand everything. If, on the other hand, you are making dictation and sound cryptic or unclear, a patient could become nervous and worried about not having a clear understanding of their doctor visit.

When making entries, beware of the easy mistakes that you can make when using forms and templates. A simple mistake in recording information on a form can cause problems. If there is an error in checking boxes on one form, could there be more errors on other forms? Making independent notes every time you record patient information better insures accuracy and credibility of information.

It is a good idea to audit and review medical records to ensure that documentation procedures are consistently used. In the audit process, a reviewer may detect entries that may require a second look. If there is an error or missing information, it is always best to make a new record and attach it as an addendum to the original. Do not change or alter records when there is active or pending litigation.

For more tips on documenting patient medical records or if you have questions about exposure and liability in the event of a patient complaint or claim for malpractice, please be in touch with Michael V. Favia and Associates, P.C.

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.

 

[i] Source for article summary: The Doctors Company, The Faintest Ink, By Carol Murray, RHIA, CPHRM, Patient Safety/Risk Manager II.

Relaxed restrictions: Health care licenses and criminal convictions

On January 1, 2017, new laws on the books in Illinois took effect. Among the new laws passed was a bill to protect applicants for professional licenses who may also have a record of a criminal offense and conviction. Prior to the new law, applicants for health care licenses[i] were barred from applying for a professional health care license if they had been convicted of criminal offenses.

In fact, a 2011 law, now rescinded, had automatically and permanently revoked or denied licenses to certain health care professionals with certain past felony convictions. Imagine working in a health care career for years and being stripped of your license to work and earn a living. Those affected by the 2011 law may now move forward in applying for the reissue of their health care license.

Those previously stripped of licenses may seek relief:

New health care license applicants who may have been precluded from receiving a license prior to January 1 may now request the issuance of a health care license by the State of Illinois. The Illinois Department of Financial Regulation (IDFPR), who issues and regulates health care licenses and professionals, may no longer deny a request for a professional license solely on an applicant’s criminal record unless the conviction is directly related to the occupation for which the individual seeks a license.

“The new measure is part of ongoing efforts by Governor Rauner and legislators to remove unnecessary barriers to the professional licensure while ensuring the health, safety, and welfare of the public.[ii]

New opportunities for independent review:

Under the law, if an individual applies for a license to work in regulated health care position, and they have a criminal conviction, the individual may qualify for special review under the new law. The Petition for Review, timely filed, can be used to affirmatively establish that the individual has been rehabilitated from their conviction.

There are several factors to be considered by the IDFPR in reviewing Petitions for Review, such as the seriousness of the underlying criminal conviction, any prior disciplinary history associated with the applicant, and notably, the individual’s voluntary remedial actions. Remedial actions can help establish an individual accepting responsibility for an error, and when coupled with rehabilitation, the decreased chances of future errant actions.

Child support obligations:

The new rule also gives the IDFPR more discretion in disciplining a license holder who falls behind in child support obligation. While it may be true that some child support obligors knowingly fail to pay child support, others may fall behind unintentionally. When the health care worker is denied their license to earn a living, and they want to be current on their support obligation, taking their income away can further complicate the problem.

If you believe the new law applies to your health care career and opportunity to hold the proper license, whether you were previously denied, suspended or revoked, you should know that every situation is fact-specific and what applies to some may not apply to others. Call Michael V. Favia & Associates, P.C. for a comprehensive review of your professional licensing matter to learn if the new law may change your health care career outlook.

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.

 

 

[i] Note: Health care workers include doctors, nurses, social workers, pharmacists, and more.

[ii] IDFPR Press Release Dated 12/29/2016, A Pathway to Licensure: Changes to Law for Health Care Workers with Criminal Convictions.

PODCAST: Medical office management tips with Donna Weinstock

Today’s podcast interview with Donna Weinstock, from Office Management Solution, a Chicago area provider of solutions and services for medical offices, focuses on current trends and topics in medical practice management. In the next 30 minutes, Donna will talk to us about her approach to running a business and healthcare practice and offer examples of opportunities in improving our operations, patient service and employee retention. Click/tap here to listen to the interview anytime.

Topics covered in this 30-minute interview:

  • Why medical offices need policy manuals;
  • How to best divide and delegate tasks;
  • Making smart choices when recruiting employees;
  • When it makes sense to use outsource solutions;
  • Services provided by Office Management Solution.

Donna Weinstock is president of Office Management Solution. She has spent over 30 years in healthcare, first working in physician offices as a biller and receptionist and later as a practice manager.

This has allowed her to truly understand the workings and day to day operations of healthcare practices which now allows her to help her clients/physician practices to become more efficient and therefore more profitable.

Donna is a is a speaker and writes for healthcare magazines.

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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.

Experience matters: Hiring the best healthcare licensing lawyer

How much did it cost you to become a licensed and practicing healthcare professional? While doing the math, in addition to the hard cost of tuition for many years of school, remember to include the opportunity cost of all else you may have done to earn money while you dedicated your life and career path to healthcare practice. In addition to money, the time and other resources invested in a healthcare practice are significant. It is safe to say that healthcare professionals have too much to lose to gamble with a licensing dispute or discipline.

There appears to be an increase in the coverage of healthcare discipline and regulation.

Doctors, dentists and nurses all understand that frivolous complaints are filed from time to time and the regulatory agency charged with oversight has a duty to follow up on any and all reported incidents. Even if you assume you are in the clear and can handle everything on your own, it is possible to stumble on an unknown regulatory or legal issue and it is never good to be caught off guard when defending your practice.

There are incentives for people to report the alleged misconduct of others, particularly in healthcare practice. Consider the amount of coverage given to cases of Medicare billing fraud. People who report Medicare fraud can receive compensation for being the whistleblower. A less than ethical individual may target practitioners with high volume practices if they think there is a chance an error may lie somewhere in the billing files, and they might get lucky.

When winning and defending your practice matters, so does experience.

The increase in demand for healthcare professionals leads to an increase in all the industries supporting healthcare practice, including the legal industry. As increased manpower and technology allows for more opportunities to regulate and oversee healthcare practices, there is an increased need for skilled and experienced attorneys to advise and represent licensed healthcare practitioners.

Chicago healthcare law and licensing attorney, Michael V. Favia humbly finds himself among the best healthcare attorneys in the State of Illinois. Favia’s career has afforded him the opportunity to work for the State as well as in private practice, on both sides of the fence. As a former chief prosecutor for the IDFPR, then the Illinois Department of Professional Regulation, Favia is intimately familiar with the outlook and position of the Department, when it investigates and makes discretionary decisions whether to proceed with the investigations that can lead to discipline and serious consequences.

Read Michael V. Favia’s LinkedIn profile for a full list of career accolades and experience.

Working in private practice, counseling and representing Illinois-licensed healthcare practitioners, defending their licenses and careers, Favia has also had the opportunity to share experience and wisdom with other attorneys learning healthcare law. Only through many years of experience in the trenches does a professional develop the right intuition and knowledge base to be the senior practitioner to mentor others. In building his career, Favia has worked with other leading healthcare lawyers, associating and collaborating on cases; he is the one they turn to when they need additional counsel.

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.