healthcareA new federal investigative unit will prosecute defendants for a variety of crimes related to health care fraud in Illinois.

The Acting U.S. Attorney for the Northern District of Illinois recently announced that the new unit will pursue many different types of alleged health care fraud perpetrators, including medical providers who falsify records to justify expensive treatments and participate in fraudulent billing.

Joel R. Levin, the Acting U.S. Attorney, noted that private insurers and Medicare lose millions of dollars annually to health care fraud. The crime also poses a burden to patients who are subject to unnecessary medical tests and other procedures. Perpetrators must be held accountable.

The Office of Inspector General of the U.S. Department of Labor, the U.S. Food and Drug Administration, the U.S. Postal Inspection Service, the Office of Inspector General of the U.S. Department of Health and Human Services, and the Federal Bureau of Investigation’s Chicago offices also will participate in the ramped-up prosecutions.

Expanding Prosecution Efforts

The new Health Care Fraud unit will include five prosecutors, adding to the ability to prosecute large health care fraud cases. Recently, the office took part in the biggest enforcement action related to health care fraud in the history of the Department of Justice. The effort included 15 defendants who were charged in the Northern District of Illinois — and a total of more than 400 throughout the United States.

The unit has participated in a number of other significant prosecutorial efforts. One case involves a chiropractor, along with his father and brother. Each of the men received prison time related to a fraudulent billing plan that gained more than $10.8 million from insurance companies. The men used the chiropractic clinic to bill for services that were not necessary or that were never provided. The sentences ranged from two to seven years in prison.

In another case, 10 individuals were criminally convicted in relation to a long investigation into Chicago’s Sacred Heart Hospital. For more than 10 years, hospital executives were involved in a conspiracy to pay bribes and kickbacks to doctors in exchange for referrals that were billed to Medicaid and Medicare. The hospital earned millions of dollars due to the scheme.

Several doctors — along with the hospital’s owner and chief executive officer, the chief financial officer, and two chief operating officers — were convicted, and the hospital closed in 2013.

Home Health Care, Controlled Substances Draw Scrutiny

The new unit also will continue to prosecute fraud in hospice and home health care. Investigations into frauds related to home health care have led to convictions of medical professionals, executives and marketers in numerous companies.

A recent investigation into a hospice organization resulted in prison time for several defendants, including the company’s owner, who received a sentence of more than six years in prison. Meanwhile, a former nursing director with the company was sentenced to 20 months.

The Health Care Fraud Unit also will continue to investigate the misuse of controlled substances, including fighting offenses that contribute to the opioid crisis. In one recent case, a doctor pleaded guilty to charges of prescribing drugs like Hydrocodone to patients he had not examined; he received a sentence of 18 months in prison.

Expected Effects of the New Unit

Across the country, U.S. Attorneys Offices have significantly ramped up enforcing health care fraud, having begun 975 new criminal investigations just in 2016. The expansion of capacity in the Northern District of Illinois office with the addition of the new unit is expected to have a number of effects.

For example, more criminal investigations and prosecutions are anticipated. With more dedicated prosecutors, the office will increasingly focus on criminal prosecutions related to health care fraud. More search warrants and subpoenas issued by grand juries also can be expected.

Civil enforcement investigations, and subsequent actions, also are expected to increase. In addition, the added capacity of the office may make it a destination for whistleblowers who wish to report fraud and abuse under the False Claims Act to collect a bounty.

Types of Health Care Fraud

Criminal activity relating to health care can manifest in a variety of ways, all of which may be investigated and prosecuted by the new Health Care Fraud Unit. The most common forms of health care fraud include billing for services that were not provided, either through identity theft or through the use of real patient information.

In some cases, medical providers may bill for services that are more expensive than the services that were actually performed, a practice known as “upcoding.” Performing services that are unneeded, misleading patients about what treatments are necessary, falsifying diagnoses, taking kickbacks for referrals, and overbilling insurance companies while waiving patient charges also are among common fraudulent health care schemes.

If you believe that you are the subject of a health care fraud investigation, it’s vital that you speak with an experienced attorney. Michael J. Petro has provided top-notch criminal defense against health care fraud accusations for over twenty years. For a consultation, contact the office Michael J. Petro.

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