What Are the Penalties for Medicare Fraud in Illinois?

It is a tough time to run a medical business in Illinois. Almost no day goes by without breaking news about indictments, arrests, and search warrants against physicians, mental healthcare providers, and Medicare businesses in Illinois. When it comes to protecting yourself against unfair allegations and securing your livelihood, you should not experiment. Consider speaking to attorneys with a proven track record of helping hundreds and hundreds of healthcare providers across the United States, including throughout Illinois— today and free of charge. Avoid these consequences, call 888-680-1745. We have successfully represented:

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Speak with Medicare Fraud Defense Attorney Dr. Nick Oberheiden on Weekends or Today at  888-680-1745.

Mental healthcare providers, cardiologists, doctors of all specialties, and healthcare businesses trust Oberheiden, P.C. Unlike any firm you might see, the attorneys of Oberheiden PC offer demonstrated knowledge and results by focusing their practice on defending good people like you against healthcare fraud accusations. We have avoided criminal charges in hundreds of federal Medicare fraud investigations and we would be happy to assist you as well.

Meet attorney Dr. Nick Oberheiden, the owner of Oberheiden, P.C. Nick limits his practice to federal law and in particular federal healthcare fraud defense work. In hundreds of cases, Nick has helped physicians and entrepreneurs to maintain their license, keep their freedom, and enjoy their future. Nick has built a team of former Justice Department officials and senior federal attorneys to stand up for and help people like you.

What Does the Government Have to Prove in Illinois Medicare Fraud Cases?

Medicare Fraud is structured as a federal offense. Pursuant to 18 U.S.C. 1347, an individual is guilty of healthcare fraud in Illinois federal court if the government prosecutors can prove beyond a reasonable doubt that the following mandatory elements exist:

  • The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a healthcare benefit program or obtain money or property from a healthcare benefit program by means of false or fraudulent pretenses, representations, or promises;
  • The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the healthcare benefit program; and
  • The defendant acted with the intent to defraud the healthcare benefit program.

Because healthcare fraud and Medicare fraud are federal offenses, violations are typically investigated by Chicago-based federal law enforcement agencies such as the Federal Bureau of Investigation (FBI), the Drug Enforcement Administration (DEA), the Office of Inspector General (OIG), the Illinois Medicaid Fraud Control Unit (MFCU), and prosecuted by Assistant United States Attorneys from the U.S. Attorney’s Office in Chicago, Illinois.

What Are the Penalties for Criminal Medicare Fraud in Chicago?

If you have any concerns regarding the penalty calculation for Medicare Fraud in Illinois or need to get guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends. Call 888-680-1745.

Chicago prosecutors have a reputation for accusing healthcare business owners and physicians of Medicare Fraud. Notably, Chicago is home to the Chicago Medicare Fraud Strike Force, a special government task force created to prosecute Medicare Fraud more aggressively and more relentless than in other parts of the country. The following examples show severe a conviction of Medicare Fraud can be in Illinois. Generally speaking, a defendant guilty of Medicare fraud will be ordered to not more than 10 years imprisonment per count, a term of supervised release, criminal fines; asset forfeiture, and a mandatory special assessment. The exact penalty depends on the amount that the defendant was found guilty of having damaged CMS/Medicare as calculated under the Federal Sentencing Guidelines. The higher the damage amount, the higher the sentence.

  • The billing specialist for an Illinois based home health company was convicted by a federal jury for his role in a scheme to defraud Medicare. According to evidence presented at trial, the biller submitted bills to Medicare for services that were never provided. The biller would bill for services under patients that were dead and would bill for doctor provided services when in fact no doctors were employed with the home health company. The fraudulent bills were then sent to Medicare for reimbursement. As a result of the scheme, Medicare paid out $4.5 million. The biller was convicted of one count of conspiracy to commit healthcare fraud, six counts of healthcare fraud and three counts of false statements relating to a healthcare matter.
  • A husband and wife in Chicago were indicted for their role in a scheme to defraud Medicare. According to the indictment, the husband and wife ran home health companies in Chicago and submitted bills to Medicare for patient services that were either medically unnecessary or were not provided. The husband and wife allegedly paid bribes to obtain Medicare beneficiaries and would falsify these patients’ medical records to make them eligible for home health services. The indictment further alleges that the husband and wife tried to conceal the illegal monetary gains from the scheme by making the money appear as business expenses. As a result of the scheme, Medicare paid $45 million.
  • A hospital service provider based in Illinois has agreed to a monetary settlement with the United States for its role in submitting fraudulent bills to Medicare. According to the settlement, the service provider engaged in systematic “up coding” of medical procedures performed at various hospitals. The service provider would submit bills to Medicare for more expensive procedures that what was actually performed. As part of the settlement, the service provider has agreed to pay $60 million back to Medicare and to also enter into a corporate integrity agreement. The corporate integrity agreement is supposed to increase compliance within the service company’s billing department. Since these allegations were resolved with a settlement, there has been no finding of liability against the service provider.
  • An Illinois oncology center has agreed to a monetary settlement with the United States for its alleged role in defrauding Medicare. According to the settlement, the oncology center was double billing Medicare for certain procedures and billed Medicare for procedures that lacked proper documentation. To settle these allegations, the oncology center will pay $2 million back to Medicare. Since this case was resolved with a settlement, there has been no finding of liability against the oncology center.
  • An Illinois man was indicted for his role in submitting fraudulent bills to Medicare. According to the indictment, the man owned a home health agency and would falsify patient records to certify them for home health services. The man would then bill Medicare for services based on these fraudulent certifications. The man also allegedly billed Medicare for services that were never provided. As a result of the scheme, Medicare paid out $12 million.

What Is the Statute of Limitations for Medicare Fraud in Illinois?

In Illinois criminal healthcare fraud investigations, the Statute of Limitations is typically five years. However, 18 U.S.C. 3282 is subject to various exceptions that can prolong the allowable prosecution phase, in particular if the case is charged as a federal healthcare fraud conspiracy.

What Are the Penalties for Civil Medicare Fraud in Illinois?

In civil Medicare fraud cases, the government does not claim intent. The mere fact that your business violated Medicare rules (for example by submitting false and fraudulent claims, physician self-referrals, kickbacks, drug price reporting, and other violations committed without criminal intent) is enough for the Office of Inspector General and other federal law enforcement agencies to target you with penalties ranging from tens of thousands of dollars for each single rule violation.

If not represented appropriately, you may reach the stage of bankruptcy. Effective defense against penalties ranging from the tens of thousands of dollars for a single submission of a false claim under the Civil Monetary Penalty Law (CMPL) requires proven knowledge of healthcare laws and the ability to make compelling arguments in front of federal prosecutors and judges.

Nick Oberheiden has avoided liability for clients across the United States in dozens and dozens of civil fraud cases. Call him directly and today at  888-680-1745. to hear what he would do to protect your business and your assets.

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