West Suburban Doctor Sentenced to Two Years in Federal Prison for Falsely Approving Unnecessary Treatment
CHICAGO — A west suburban physician was sentenced today to two years in prison for fraudulently certifying patients as confined to the home, allowing healthcare agencies to bill Medicare for millions of dollars in 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. Davida acknowledged in a plea agreement that he provided the certifications because he feared that, if he didn’t, the home-health agencies would stop sending him the referrals.
In imposing the 24-month sentence, U.S. District Judge John J. Tharp Jr. described the crime as a “very serious offense,” and one that involved “stealing money” from the Medicare program.
Davida, 62, of Bloomingdale, pleaded guilty last year to a health care fraud charge contained in a criminal information. 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 in need of skilled nursing services, when, in fact, they were able to leave their homes and did not need such services. The certifications caused the home-health agencies to submit claims to Medicare for payment of bills pertaining to medically unnecessary services.
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 sentence was announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Michael J. Anderson, 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 government is represented by Assistant United States Attorney Stephen Chahn Lee.
The investigation was carried out by the Medicare Fraud Strike Force, which consists of agents from the FBI and HHS, 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 enforce anti-fraud laws around the country.
To report health care fraud or to learn more about HEAT, logon to: StopMedicareFraud.gov.