The Illinois Medical Practice Act is an essential state law that governs the practice of medicine in our state; without it, any person regardless of quali cation could practice medicine in Illinois without restriction or penalty. Because medicine is an ever-changing eld, the Act is set to expire on a regular basis, enabling the legislature to ensure that the law keeps pace with the current state of medical practice. Unfortunately, this regular expiration has also allowed politicians and interest groups to use this indispensable piece of legislation as a tool for exercising political in uence.
Since its inception a decade ago, the Medicare Fraud Strike Force has charged more than 3,500 people with ‘ripping off’ Medicare as of early 2017. These are nine teams (made up of agents, investigators, prosecutors, auditors, etc) based in fraud hot spots such as Miami, Los Angeles, Detroit, Southern Texas, New York City, Southern Louisiana, Chicago and Tampa.
Here are some examples of the type of cases that the Medicare Fraud Strike Force goes after:
1.) Using Fake Patients for Payment.
Miami based agents investigating Medicare Fraud heard of suspicious practices of a psychiatric medical facilities recruiting patients, and so they started investigating. Here is what they found: medical facilities were paying recruiters to scare patients. Many of those people were drug addicts who were not in need of psychiatric services, but were looking for case or substance-abuse treatment. They were coached to say that they were suicidal to generate bogus Medicare claims. The CEO of the facility was convicted and sentenced to serious jail time.
2.) False Billing by Healthcare Providers.
These health care companies were billing Medicare for bogus home health services. The task force carefully checked patient records and compared them for billing records and found instances where patients were not care for, but the health care providers were billing anyways. Some patients were given expensive treatments that they did not need, and Medicare was even billed for services that did not happen at all.
3.) The Opioid Medicare Connection.
Medicare numbers are worth more on the black market than credit card numbers, since Medicare numbers can be used to bogus opioid prescriptions. The pills are then sold on the street for big profit. Monitoring opioid prescriptions is difficult because they are so frequently given to patients in pain. One in three Medicare Part D beneficiaries received at least one opioid prescription in 2016. One case in Detroit involved a doctor who used recruiters to find patients whose Medicare numbers he could steal. He would then use those numbers to give patients painkillers for cash. This particular doctor was sentenced to 23 years in prison.
Women who have vaginal mesh implants to support their bladders often have discomfort. These women sometimes find themselves falling prey to a burgeoning industry that makes money by coaxing women into have surgery – sometimes unnecessarily — so that they are more lucrative plaintiffs in a lawsuit against medical device manufacturers. Court records suggest that perhaps thousands of women have been sucked into unnecessary surgeries, which may have horrendous complications.
The litigation surrounding mesh implants is lucrative. Millions of women, world wide, have received them,and many women do in fact complain that they cause bleeding and/or pain during sexual intercourse. But, surgery is not always, or even often, the answer.
The Illinois Department of Financial and Professional Regulation will prosecute doctors for performing unnecessary procedures, and rightfully so, as it is a violation of state and federal criminal law to perform and bill for a procedure that is not medically necessary. Charges of Medicare and Medicaid fraud are also likely.
Doctors must be wary of arrangements with lawyers and or third parties who are arranging to find patients for them. It is illegal to pay a referral for patients.
“I’d rather see a female doctor.” In a male-dominated profession, this request is not common, unless we are speaking about gynecology. From 1970 to today, the percentage of women gynecologists jumped from 7 percent to 59 percent. Male physicians fear that due to the decline in number of male gynecologists, their gender may eventually be excluded from the speciality altogether. The Chicago Tribune article, Male OB-GYNs are in the decline by Soumya Karlamangla mentions an instance of this gender preference. Brooke Hamel, a 19 year old girl from Virginia, recently went to the gynecologist to get a intrauterine device inserted. “He touched me and I immediately lost it… As soon as I had to spread my legs, I was in a really vulnerable place, and I did not want to be in that position with a male.” Outside of this speciality, fewer than a third of physicians are females. Men are now less likely than ever to try and become an OB-GYN due to this controversy. If the drop in number of male gynecologists continues, this could weaken the field overall. In terms of care, male and female OB-GYNs have the same education and practice. Preference in gender is only a matter of what the patient feels most comfortable with. On the other hand, there are women who prefer male OB-GYNs stating they are more gentle and better listeners. Perhaps this is due to the need to overcome this uprising stereotype.
On March 12, 2018, Jonathan Reisman wrote an article for the Chicago Tribune called ‘Judgment calls: Who really needs a pain killer?’ Dr. Reisman is an emergency room physician at Schuylkill Medical Center in Pottsville, Pensilvania. Dr. Reisman explains how the presence of drug seekers has negatively impacted many physician’s practice.
Opioids have become quite the ‘hot’ topic in today’s society . When used properly they are a powerful blessing but when not properly used, they have an incredibly destructive potential. A popular question amongst doctors is whether or not to prescribe opioids. Patients have a tendency to exaggerate pain in order to receive painkillers. Some of the patients seek a buzz while others are trying to find a fix for opioid withdrawal, which is an painful and unpleasant condition. Due to this strong presence of drug-seekers, physicians have found prescribing opioids an incredibly difficult decision to make. This epidemic is spreading rapidly and tainting the way physician’s think and it is beginning to cast doubt over clinical instincts. Physicians enabled this epidemic and are now tasked with its salvation.
The Federal Drug Enforcement Administration brings physicians a great responsibility and minimal insight on discerning diseases from ‘drug-seekers’. The misuse of opioids is nuclear and brings about death and destruction. But, when used properly they have an unbridled power that almost immediately relieves patients of antagonizing pain. Opioids are a double edged sword that are extremely concerning and hard to ignore. Doctors are being faced with under treating pain or feeding an addictions; being pulled in opposite directions by a patient’s pain and a national crisis. In the 1990’s there was a horrifying under treatment of pain that angered the public. Physician’s have the power to alleviate pain but are withholding from it. In order to not re-live the past, a physician’s decision to prescribe or administer opioids tends to be influenced by this phenomenon that occurred in the 90’s. So, now what? Patient pain is a daily conundrum and the decision on whether or not to prescribe opioids has become an emotional tug for physicians.
The Medical Disciplinary Board’s purpose is to consider allegations of misconduct or malfeasance by members of the medical professions and to recommend appropriate discipline to the Secretary. The Board receives complaints through the investigative process, and through citizens who inform the Department of potential violations. The Board is composed of eleven members appointed by the Governor, seven of whom are physicians with representatives of the osteopathic and chiropractic branches included, and four of whom are members of the public. These are the Board Members listed as of January 30, 2018.
Sarita M. Massey M.D. | Chicago
Richard R. Fay D.C. | Wheaton
Ronald L. Johnson M.D. | Pittsfield
Grace Allen Newton JD, Public Member | Chicago
Frank J. Nicolosi M.D., J.D. | Rockford
Karen O’Mara D.O. | Chicago
Joseph W. Szokol J.D., M.D., MBA | Winnetka
Kenneth L. Schiffman M.D. | Oak Park
Henry C. Krasnow J.D., Public Member | Chicago
Garrick J. Hodge J.D., M.B.A., Public Member | Wadsworth
As set forth in the Illinois Medical Practice Act (“Act”), physicians are required to complete a report for the following: a. Adverse final action taken against you by any of the following:
another licensing jurisdiction (any other state or any territory of the United States or any foreign state or country),
peer review body,
health care institution,
professional society or association related to practice under the Act,
law enforcement agency,
court for acts or conduct similar to acts or conduct which would constitute grounds for action as defined in the Act, or
state or federal agency that restricts or prohibits you from providing services to the agency’s participants.
Surrender of a license or authorization to practice as a medical doctor, a doctor of osteopathy, a doctor of osteopathic medicine, or doctor of chiropractic in another state or jurisdiction, or surrender of membership on any medical staff or in any medical or professional association or society, while under disciplinary investigation by any of those authorities or bodies, for acts or conduct similar to acts or conduct which would constitute grounds for action as defined in the Act; or b. c.
2. Email complete signed forms to FPR.MedicalAdverse@Illinois.gov within 60 days. Adverse judgment, settlement, or award arising from a liability claim related to acts or conduct similar to acts or conduct which would constitute grounds for action as defined in the Act.
The following is required:
Physician Name: Physician License No.: Physician Email: Physician Phone No.: Physician Address: (City, State, Zip Code) check if address changed PHYSICIAN ADVERSE ACTION INFORMATION Date of Occurrence: Description: Please use additional pages if needed and attach all relevant documentation (including, but not limited to a copy of an adverse final action taken against you).
Effective January 1, 2017, previously barred health care workers and first time applicants may become eligible for a license. Under the Department’s new process, a health care worker who was permanently revoked or denied due to a forcible felony may file a Petition for Review, which is currently available on the Department’s website. The review process does not apply to a forcible felony requiring registration under the Sex Offender Registration Act, involuntary sexual servitude of a minor, or a criminal battery against any patient in the course of patient care or treatment that is a forcible felony. Information about applying for licensure are available on the Department’s website.