Chicago Health Care Fraud

Health care fraud is serious. Federal and State law enforcement use task forces, undercover operations, data analysis, and other means to find and uncover fraudulent activities.

Health Care Fraud in Chicago, Illinois

The United States constantly monitors various regions for health care fraud. Chicago is one of those regions, and it is monitored by a Medicare Fraud Strike Force.  Chicago faces constant monitoring because of the prevalence of health care fraud in the area.

In 2016, the Department of Justice released a statement that revealed a nationwide arrest of more than 300 individuals for health care fraud. Individual healthcare providers were at the center of 80 of those investigations—the other cases centered around health care entities and businesses. The Medicare Fraud Strike Force recovered more than $900 million in fraudulently paid out claims.

health care fraud

Healthcare Investigations and Audit Defense in Chicago

Successfully defending healthcare investigations, health care fraud, and provider audits requires experienced medical law professionals. Successfully defending the allegations of fraud or overbilling often requires expert input to challenge the denial of a claim based on lack of medical necessity or fighting an extrapolation.

Rosenblat Law, a Medicare and Medicaid Audit defense law firm located in Illinois, has the unique ability to put together the best challenges to a health care fraud investigation, defend a recoupment decision, or represent you or your company during a provider audit.

Our “no ego” approach puts the client’s needs at the forefront of all our decisions. If you are being investigated or have been charged with a health care fraud-related offense, contact health care fraud criminal defense attorney Michael C. Rosenblat. A former prosecutor with the Illinois Medicaid Fraud Control Unit.

What We Do

Rosenblat Law is a Chicago healthcare law firm that represents providers in RAC Audits (Recovery Audit Contractors), ZPIC Audits (Zone Program Integrity Contractors), private payor audits (Blue Cross Blue Shield, Aetna, etc.), Medicaid OIG Audits (Illinois Department of Healthcare and Family Services/Office of Inspector General), and MFCU Audits and Investigations (Medicaid Fraud Control Unit).

Our Chicago health care fraud defense team will be composed of Medicare and Medicaid fraud lawyers who are ready to confront your specific challenges. Your defense team will consist of a former Illinois MFCU prosecutor and will collaborate with other former prosecutors, billing, and compliance experts as needed.

We use our experience, insight, and relationships with the government to defend our clients aggressively and negotiate a favorable resolution when necessary. Our lawyers defend clients from across the health care industry, including:

  • Individual doctors, nurses, and pharmacists
  • Durable Medical Equipment Companies (DME)
  • Home health care companies
  • Dentists and Dental Clinics

Rosenblat Law works with healthcare providers to provide the representation and services that the healthcare provider needs.

Rosenblat Law can provide complete representation to physicians, dentists, nursing homes, or home health agencies. These services can be provided at an hourly rate or as a flat fee. Sit down with us for a free consultation to discuss your health care fraud representation.

Illinois Healthcare Fraud and Medicare Fraud Enforcement

In Illinois, healthcare fraud is civilly and criminally prosecuted by the United States Attorney’s Offices, the Office of the Illinois Attorney General, and county State’s Attorneys.

The United States Attorney and Illinois Attorney General often work with whistleblowers to curb fraudulent activities.  Modeled after the federal False Claims Act, the Illinois False Claims Act permits private citizens to bring qui tam actions on behalf of the State of Illinois to recover damages and mete out civil penalties.

The liability provisions of the Illinois False Claims Act, §740 ILCS175/3(a)(1), provides liability for any person who:

  • knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval.
  • knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim.
  • or conspires to commit a violation of the False Claims Act

Examples of Chicago Healthcare Fraud

Typical healthcare fraud cases include Medicare, Medicaid, or private insurance fraud. Health care fraud often involves overbilling, billing for services that were not provided, or billing for services that were not medically reasonable and necessary.

Alleged healthcare fraud offenders could be:

  • Clinics
  • Health insurers
  • Hospitals and their systems
  • Home healthcare companies
  • Physicians and Dentists
  • Medical institutions
  • Medical facilities
  • Nurses
  • Pharmacists

Healthcare fraud allegedly committed against Medicare, Medicaid, or a private health insurance company can include the following offenses:

  • Violating the Anti-Kickback Statute
  • Billing for medically unnecessary services
  • Billing for services never provided
  • Billing for services provided by staff or assistants as if a physician provided the services
  • Prescribing medications, including controlled substances without medical necessity
  • Submitting duplicate claims for the same service
  • Waiving co-pays

Healthcare fraud prosecutions have been increasing over the past several years. Healthcare fraud is estimated to cost the United States over $80 billion a year, and that figure is increasing.

Type of Audits

fraud audits

There are several types of audits. A RAC Audit is an audit conducted by a Recovery Audit Contractor, a private company acting on behalf of the Center for Medicare and Medicaid Services. RAC’s are paid on a contingent fee basis and are thus incentivized to find and recover alleged overpayments.

ZPIC Audits: Zone Program Integrity Contractors are tasked to identify fraud and should raise heightened concerns for providers when compared to a RAC Audit.

The Medicare Appeals process has five levels of appeal:

  • Redetermination
  • Reconsideration, conducted by a Qualified Independent Contractor (QIC)
  • Hearing before an Administrative Law Judge
  • Hearing before the Medicare Appeals Council
  • Judicial review

Rosenblat Law provides experienced legal defense in Chicago, Illinois, and the surrounding areas for healthcare providers, businesses, and entities being investigated for healthcare fraud.

Experience as a former healthcare prosecutor and experience as a defense attorney provides a unique perspective on how to best handle these types of cases and your representation.

Chicago Healthcare Fraud Defense

Rosenblat Law will use its experience, knowledge, relationships, and skills to protect you and your business. These common defenses could include insufficient evidence or a lack of criminal intent.

If you need an experienced health care fraud attorney in Chicago or throughout Illinois, contact Rosenblat Law today for a consultation to discuss your options.

A Clear Defense Advantage

Rosenblat Law’s experience in criminal and civil health care fraud provides its healthcare provider clients with the insight and experience to avoid or mitigate potential criminal or civil exposure.

If you are being investigated or audited, contact attorney Mike Rosenblat to discuss your representation. Mike Rosenblat has been practicing healthcare law for over twenty years — since he was an Assistant Attorney General assigned to the Medicare Fraud Control Unit. You can contact Rosenblat Law at 847-480-2390 or by emailing Mike at mike@RosenblatLaw.com.

Rosenblat Law has offices located in Northbrook and Chicago, Illinois.