Tag Archives: Whistleblowers

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.

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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.

 

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.

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.