How Unscrupulous Physicians in Illinois Profit from Misuse of Medical Coding and Billing

Although physicians are not required to swear the original Hippocratic Oath, written in 500 BCE and detailing a moral code of contact, they do vow similar sentiments. The modern version essentially states to “do no harm” and also consider patients’ social and financial well-being when treating them. Unfortunately, there are unscrupulous physicians out there who abuse their position for personal financial gains. In Illinois, the lax medical regulations have made it possible for even disgraced doctors to line their pockets at the expense of their patients.

Growth of the home healthcare industry

In 2016, the industry added 35,000 jobs per month on average – many of them in home healthcare – to cope with an aging population. Many disabled people or elderly individuals who want to avoid having to go to nursing homes or hospitals rely on the services home healthcare can provide. It is a profitable business that in Illinois only requires a $25 licensing fee – and no criminal background check. With a surge in new home healthcare companies, the state’s public health regulators are unprepared to keep up and issue licenses without properly vetting applicants. 

The prevalence of fraud and misrepresentation

Many of these home healthcare companies operate in the best interests of their patients. However, fraud is prevalent throughout the industry, putting patients’ lives at risk. Corrupt physicians – some whom have lost their malpractice insurance, hospital privileges and professional standing – have infiltrated the industry with disregard for patient care, motivated by greed and personal gain. By misusing and inflating medical coding and billing, unethical doctors and home healthcare agencies scam patients, “robbing” taxpayer-financed programs. They may falsify patient medical histories and diagnoses; order unwarranted procedures, therapies and tests; and prescribe unnecessary or addictive drugs.

How the scamming works

In most areas of medicine, physician referrals are required to qualify for insurance coverage. However, Medicare permits home health agencies to take on patients before they are certified for care – something that happens often in Chicago. Once the agencies or the doctors on their payrolls falsely certify that patients are home-bound and require skilled nursing care, Medicare pays them – and they profit. They rake in the money as long as no one reports otherwise. There are “patient brokers” unprepared to keep up and issue licenses without properly vetting applicants.

The prevalence of fraud and misrepresentation

Many of these home healthcare companies operate in the best interests of their patients. However, fraud is prevalent throughout the industry, putting patients’ lives at risk. Corrupt physicians – some whom have lost their malpractice insurance, hospital privileges and professional standing – have infiltrated the industry with disregard for patient care, motivated by greed and personal gain. By misusing and inflating medical coding and billing, unethical doctors and home healthcare agencies scam patients, “robbing” taxpayer-financed programs. They may falsify patient medical histories and diagnoses; order unwarranted procedures, therapies and tests; and prescribe unnecessary or addictive drugs.

How the scamming works

In most areas of medicine, physician referrals are required to qualify for insurance coverage. However, Medicare permits home health agencies to take on patients before they are certified for care – something that happens often in Chicago. Once the agencies or the doctors on their payrolls falsely certify that patients are home-bound and require skilled nursing care, Medicare pays them – and they profit. They rake in the money as long as no one reports otherwise. There are “patient brokers” for fraudulent agencies who actively solicit potential elderly victims in stores, food pantries, churches and even at bus stops, and they receive illegal kickbacks for their efforts. According to the Chicago Tribune, at least 15 Chicago-area doctors have been charged with or convicted of paying or accepting kickbacks in the last seven years. An overworked system is partially to blame for the healthcare fraud that Illinois faces, and a return to ethics is called for.

Taking an ethical stand

Northwestern College, in addition to providing excellent education, strives to instill the importance of ethics to its students. Regulations regarding licensing and certification in the healthcare industry require that everyone employed in the field has the proper training and qualifications. Northwestern College supplies students with the required skills necessary for employment in hospitals, clinics, private practice and more. In addition to providing practical training and education, NC encourages personal growth and ethical behavior that lead to continued opportunities and success throughout your career.

Northwestern College’s broad range of healthcare programs

The healthcare industry is facing many challenges this year because of policy changes, new players and health crises, among others. This has also led to tremendous growth and the need for more healthcare professionals.

According to the Bureau of Labor Statistics, employment in healthcare occupations is expected to grow 18 percent by 2026 – adding about 2.3 million jobs. The School of Health Sciences at Northwestern College offers several programs that can have you in an entry-level position in the healthcare industry in two years or less. Flexible schedules and affordable payment plans are available to accommodate students’ lifestyles and responsibilities.

Choose a course of study at Northwestern College and become a:

• Coding specialist: Medical coding is essential to the healthcare industry. Medical coding is necessary for reimbursement, tracking and clinical decision support. Coding also aids in detecting fraud and abuse.
• Medical assistant: Work with doctors, helping to perform a variety of clinical and administrative duties that are essential to the smooth operation of a doctor’s office, hospital or medical clinic.
• Health information technician: Help maintain vital patient information and records, making it portable and easily sharable among medical professionals while keeping it protected and secure.
• Radiologic technician: Learn to use x-ray radiation to perform procedures for use in the diagnosis and treatment of illnesses, diseases and injuries.
• Dental assistant: Work alongside dentists performing an assortment of duties, from taking x-rays and readying dental tools, to scheduling patient appointments and keeping records.At the Violet L. Schumacher School of Nursing at Northwestern College, train to become a nurse – the foundation of every healthcare organization. Patients will trust you for their hands-on care and will look to you as a liaison between them and the rest of the healthcare community.With all of the Northwestern College programs, your curriculum is a blend of hands-on experience and traditional classroom learning. It’s a well-rounded education that gives you a firsthand look at what to expect when you are in the workforce.To get an education you can be proud of and an in-demand career position to aspire to, contact Northwestern College today.

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