West Suburban Doctor Pleads Guilty to Causing $4 Million Loss to Medicare by Falsely Approving Unnecessary Treatment
CHICAGO — A west suburban physician pleaded guilty in federal court today to a charge that he fraudulently certified Medicare patients as confined to the home, allowing healthcare agencies to bill Medicare for unnecessary in-home treatment.
As an employee and part-owner of Bloomingdale-based Home Care Physicians Inc., DR. ARTHUR DAVIDA received referrals from home-health agencies asking him to certify the patients as confined to the home. Although he knew that at least 20 percent of the patients were not confined to the home, Davida nonetheless provided the certification – allowing the agencies to bill Medicare for treatment that Davida knew was not medically necessary, according to a written plea agreement. Davida provided the certifications because he feared that, if he didn’t, the home-health agencies would stop sending him the referrals, the plea agreement states.
Davida, 62, of Bloomingdale, pleaded guilty to a health care fraud charge contained in a criminal information. He faces a maximum sentence of ten years in prison when U.S. District Judge John J. Tharp Jr. sentences him on December 16, 2015, at 1:30 p.m.
Per Medicare’s rules, patients need to be certified as confined to the home before Medicare will pay for the specialized nursing care available to such individuals. A physician’s certification is provided on a patient’s plan of care, which is typically prepared by the home-health agencies that perform the service. According to the plea agreement, Davida began working at Home Care Physicians in 2009, and started conducting in-home visits in 2010. From 2010 and continuing through August 2013, Davida certified numerous patients as confined to the home and needing skilled nursing services, when, in fact, they were able to leave their homes and did not need such services, according to the plea agreement.
The certifications caused the home-health agencies to submit claims to Medicare for payment of bills pertaining to medically unnecessary services, the plea agreement states. Home-health agencies were paid more than $20 million by Medicare based on orders signed by Davida. Given his admission that 20 percent of these patients were not confined to the home, Davida acknowledged in the plea agreement that he caused losses of at least $4 million to the Medicare program.
The guilty plea was announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; John A. Brown, Acting Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation; and Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General.
The investigation was carried out by the Medicare Fraud Strike Force, which consists of agents from the Federal Bureau of Investigation and the U.S. Department of Health and Human Services, and prosecutors from the U.S. Attorney’s Office and the Justice Department’s Fraud Section. The strike force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent fraud and to enforce anti-fraud laws around the country.
The government is represented by Assistant United States Attorney Stephen Chahn Lee.
To report health care fraud or to learn more about the Health Care Fraud Prevention & Enforcement Action Team (HEAT), logon to: StopMedicareFraud.gov.