Health Care Fraud

Health care fraud

Health care fraud is a growing problem and affects all states – Illinois included. It exists in many forms and practices, such as submission of fraudulent bills to Medicare and private insurers, falsification of diagnoses to justify expensive tests, and performing procedures that are not medically necessary. There have also been reports that certain long term health care facilities, including nursing homes, who are allotted money from Medicare for the care and treatment of a Medicare beneficiary, do not use all of the allotted dollars for the comprehensive care of the residents for whom the money was intended. In some cases, the nursing home provides the resident the bare minimum care and treatment to incur only a portion of the allotted Medicare money for that resident’s care, and then the retaining the rest of the money. In those situations, while Medicare (and, more broadly, the government) is a victim of fraud, the overlooked victim is often the nursing home resident who was deprived of needed care and treatment.

According to a recent Chicago Law Bulletin article, the acting U.S. Attorney for the Northern District of Illinois has established a new unit in his office to battle health care fraud because “health care providers who cheat the system must be held accountable.” So far, more than 400 defendants in 41 districts across the country, including two doctors and several other medical professionals in Northern Illinois, were charged in various schemes that involved about $1.3 billion in false billings.

The local health care fraud unit is strategically staffed with prosecutors who understand the intricacies of the health care system so that they can recognize which facilities made innocent mistakes and which ones engaged in intentional fraud.

Employees of health care facilities (especially those in the billing or accounting departments who are privy to the way the facility handles its finances as well as patient billing) can also help. Health care employees who witness or have knowledge about their employer’s fraudulent practices can also bring a legal action on behalf of the government who is being defrauded. If the case is successful, the employee may be entitled to a portion of the settlement or verdict that the government obtains.  The Law Office of Jeffrey Friedman, P.C. can represent those health care employees in these cases, as they come forward to expose this conduct, and seek to recover damages.

If you or someone you know have knowledge about a health care facility’s fraudulent practices, please call the Law Office of Jeffrey Friedman, P.C. at 312-357-1431 to discuss how we can help.

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