Another Cautionary Tale of the Perils of Alleged Fraudulent Healthcare Billing

Another Cautionary Tale of the Perils of Alleged Fraudulent Healthcare Billing

A Chicagoland area doctor has been indicted on federal fraud charges alleging that he illegally pocketed almost $1 million in payments from Medicare and Blue Cross and Blue Shield of Illinois (“BCBS”).  The physician was federally indicted on April 26, 2018, on seven counts of healthcare fraud, three counts of making false statements in relation to a healthcare matter, and two counts of aggravated identity theft.

The federal indictment alleges that the physician used his patients’ personal information without their knowledge to submit fraudulent healthcare claims.  The charges allege that from 2008 to June 2013, the physician fraudulently obtained, or caused his clinic to obtain, at least $950,000 in payments from Medicare and BCBS.

The indictment alleges numerous instances in which the physician allegedly submitted a claim to BCBS or Medicare for a non-invasive “duplex scan” which was claimed to have been performed on several patients, when in fact the tests were never actually performed.  Furthermore, it is alleged that the physician prepared a seven-page electronic medical record indicating that a patient had come to his office for a follow-up consultation and examination, when the patient had actually come to his office allegedly to simply refill a prescription.

A federal indictment only contains charges and is not evidence of guilt.  The physician is presumed innocent and is entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.  We simply bring this to your attention to alert you to examples of the focus of current prosecutorial efforts.

All levied charges carry some term of a prison sentence as a maximum punishment.  Aggravated identity theft is punishable by a mandatory sentence of two years in prison.  Healthcare fraud is punishable by up to ten years, while a false statements conviction carries a maximum of five years imprisonment.  If convicted, a court must impose a reasonable sentence under federal statutory sentencing considerations and the advisory United States Sentencing Guidelines.

Anderson, Rasor & Partners will continue to monitor developments in this area.  If you have any questions or would like to discuss the aforementioned case or any related matters, please contact the Anderson, Rasor & Partners attorney with whom you regularly work with, or any other attorney in our Healthcare Litigation Practice below.

Jason Parson, Luisa Trujillo or Christopher Heery

This memorandum is provided by Anderson, Rasor & Partners for educational and informational purposes only and is not intended and should not be construed as legal advice.