A recent investigation by the Chicago Tribune reveals the Chicago metro area has become a safe haven for fraudsters in the booming home health care services industry.
According to an estimate by federal investigators, local home healthcare providers have defrauded taxpayers of over $104 million over the last five years.
Home health care services enable disabled and elderly individuals to continue to live at home instead of resorting to nursing homes. The probe into the oversight system for home health care agencies in Chicago has revealed it is insufficient, and has allowed mediocre doctors to make millions of dollars at the expense of a vulnerable population and government healthcare programs including Medicare.
One shocking story exposed by Tribune reporters details the rise and fall of Tinley Park, a heart surgeon who, after losing his malpractice insurance and his license on account of his mediocre skills, switched to the home health care industry, where he went on to play a central role in a multi-million dollar fraud scheme involving a company called Mobile Doctors.
As part of its extensive reporting on the issue the Chicago Tribune created an animated video which explains how fraud is committed in the home health care services industry and the healthcare industry in general.
In a nutshell, people sometimes create and run companies for the sole purpose of billing Medicare and Medicaid.
When the objective is to increase billings, this is done by any means necessary, including billing for medically unnecessary services, upcoding (billing for pricier services than the ones provided), recruiting patients and paying kickbacks, billing for ineligible patients, and billing for services that were never rendered.
Because the oversight for acute care hospitals is more strict, the home health care services industry becomes very attractive for would-be fraudsters and down-and-out healthcare professionals looking to boost their earnings while remaining in the industry..
The Tribune reviewed the requirements to open and maintain a home health care company in the state of Illinois and came out with the following conclusions:
“Illinois public health regulators proved unprepared for a surge in new home health care companies, doling out too many home health licenses too fast and failing to provide meaningful oversight. Even today, most anyone can own a home health care business for a $25 license fee — no criminal background check required.”
The false billings to Medicare and Medicaid are not only a problem for taxpayers, they can also be a life hazard for the individuals whose health and well-being are no longer a priority, as the goal is to bill the government programs the maximum amount possible.
Fraudsters systematically create false diagnoses in order to justify billing for pricey treatments and procedures.
According to the Tribune’s investigation into court and enforcement records, over the last five years, thousands of Chicago area patients have undergone unnecessary procedures and tests, often receiving unneeded and potentially harmful prescriptions.
Shockingly, the journalists reveal,
“Most victims were unaware that their medical histories were hijacked by swindlers — there is no legal requirement to notify or warn patients when fraud is uncovered, or when providers are convicted of crimes.”
In some cases, Chicago area Medicaid and Medicare beneficiaries have been denied wheelchairs and convalescence care because fraudsters had previously billed the government programs for them on their behalf.
This is the least known aspect of health care fraud; it does not only bill the government for things patients do not need, but it also often deprives them of what they desperately need.
Jason Echols, Illinois director for advocacy group AgeOptions has commented, "These scammers are really smart. Anybody could be a victim."
Recently, a regulation was implemented in Illinois in 2016 to prevent fraudulent advance billings by home health care providers, but the Trump administration discontinued the program in March of this year. In Illinois, as well as in the rest of the country, hundreds of fraud complaints remain uninvestigated every year on account of lack of resources.
If you have information and proof of Chicago home healthcare scams or in any other state, where home health care companies are cheating Medicare, you can become a whistleblower to stop the scheme and perhaps earn a substantial reward. To learn more and report illegal conduct Call Us 888.742.7248 or Report Online