March 5, 2012

Hospice Firm Settles Medicare Fraud Case

by Levin & Perconti

Business is about making money. While many companies have strong values that guide their decision-making, the purpose of any business, by definition, it to make a profit for owners, shareholders, and others. The American economic engine is spurred by this basic principle. However, in some context this can cause a problem. Our Illinois medical malpractice lawyers believe this may be most evident in the context of medical care. When making a profit drives certain medical decisions, then real problems can arise for all medical consumers. It remains critical to watch out for the way these profit-incentives can enter the medical decision-making process and distort the underlying goal of necessary, safe, and needed care being provided to patients.

Distortions can be seen in many contexts. One of the most common involves providing unnecessary treatments solely because the medical providers will be getting paid for the treatment. For example, unnecessary heart stent procedures have made headlines in the last couple years. Many cardiologists have been charged with having patients undergo these risky operations when they did not actually need to do so. The long-term harm for the thousands of patients who have been hurt in this way is hard to calculate.

Each Illinois medical malpractice attorney at our firm knows that in other situations, the motivation can also lead to Medicare and Medicaid billing irregularities that can that can have federal criminal fraud implications. Take for instance, a recent settlement by a large national hospice care company. According to the Journal Sentinel, last week the organization agreed to pay $25 million to settle a fraud case against it. A former employee had come forward and explained that in her time there, the company was engaging in unscrupulous practices which prioritized billings over patient care needs.

Medicare, the government program for low-income and disabled residents, pays for 24-hour hospice care for individuals who are terminally ill. The money is supposed to be spent only in real crisis periods. However, the former employee explained that in order to bill the government for more funds, they engaged in a practice of enrolling patients who were not in this crisis period and recertifying patients who likely could have left the care.

Our Chicago medical malpractice attorneys appreciate that there are untold emotional costs with these actions that will likely never be fully understood. Having a loved one in hospice care sends a very clear message to both the individual and the family that the medical condition is dire. However, for many of these families, that emotional toll was for naught, because the actual hospice care was not needed.

This, of course, is on top of the bilking taken by taxpayers who are forced to foot the bill for unnecessary services. In fact, the cost to public coffers as a result of fraud and medical malpractice is often not given enough attention. The fact remains that the public pays for a large portion of healthcare via Medicare and Medicaid programs. When inadequate medical care is provided, the patients often require much more costly and prolonged medical care to try to minimize the consequences of the negligence. That extra care comes at a high cost, which is often borne by all us. Therefore, everyone has yet another reason to work to demand improvement in the level of medical care providing at area hospitals and clinics.


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Criminal Prosecutions for Medical Malpractice on the Rise

Dangerous Illinois Doctors Stripped of Licenses