Editor's note: So Seth will pay millions of dollars in fines and walk away...a free man. The same old story! Lucius Verenus, Schoolmaster, ProbateSharks.com
Hospice owner charged with Medicare, Medicaid fraud
An owner of an Illinois hospice company orchestrated an extensive scheme to fraudulently bill Medicare and Medicaid by elevating the level of hospice care for patients at nursing homes he controlled across the state, federal prosecutors alleged in charges unsealed today.
Seth Gillman, 46, of Lincolnwood, was charged with one count each of health care fraud and obstructing a federal audit. He is scheduled to appear at 3 p.m. before U.S. Magistrate Judge Geraldine Soat Brown.
According to the complaint, Gillman, an attorney, is the administrator and one-fourth owner of Passages Hospice, LLC, based in west suburban Lisle, and also controls Asta Healthcare Company, Inc., which operates nursing homes from Rockford to Bloomington.
The charges allege that between 2008 and 2012, Gillman trained nurses to look for signs that allegedly would qualify a hospice patient for general inpatient care, resulting in payments per day more than four times higher than routine care rates. Gillman knew that many of Passages’ patients were improperly being placed in general care, some without a medical director’s approval, according to the charges.
“In many instances, the level of hospice care allegedly exceeded what was medically necessary or actually provided, including for some patients who did not have terminal illnesses or who were enrolled far longer - sometimes for several years - than the required life expectancy of six months or less,” according to the U.S. Attorney’s Office.
In one case, Passages billed Medicare for more than four years of elevated hospice care for a patient identified as “LJ,” according to the complaint. The patient’s son told investigators that his mother appeared in no danger of dying until the last month of her life, according to prosecutors.
According to data cited in the charges, Passages submitted claims from January 2006 to late 2011 for more than 4,700 patients to Medicare or Medicaid and was paid more than $125 million from the government programs. About 22 percent of Passages’ patients in that same time period had more than six months of hospice care, with 28 patients receiving more than 1,000 days of hospice care, according to the charges.
Gillman was also accused of using the windfall to paying elaborate bonuses to supervisors based on the amount of general inpatient care they oversaw. From March 2009 to April 2011, Gillman also paid himself bonuses of more than $830,000, prosecutors alleged.
The former clinical director for Passages told agents that Gillman said if a patient was under Passages’ care, they were sick enough to warrant the elevated care, according to the complaint. When the clinical director confronted Gillman over the eligibility of one particular patient, Gillman told her to “mind her own business” because he needed the money, the charges alleged.
jmeisner@tribune.com
Seth Gillman, 46, of Lincolnwood, was charged with one count each of health care fraud and obstructing a federal audit. He is scheduled to appear at 3 p.m. before U.S. Magistrate Judge Geraldine Soat Brown.
According to the complaint, Gillman, an attorney, is the administrator and one-fourth owner of Passages Hospice, LLC, based in west suburban Lisle, and also controls Asta Healthcare Company, Inc., which operates nursing homes from Rockford to Bloomington.
The charges allege that between 2008 and 2012, Gillman trained nurses to look for signs that allegedly would qualify a hospice patient for general inpatient care, resulting in payments per day more than four times higher than routine care rates. Gillman knew that many of Passages’ patients were improperly being placed in general care, some without a medical director’s approval, according to the charges.
“In many instances, the level of hospice care allegedly exceeded what was medically necessary or actually provided, including for some patients who did not have terminal illnesses or who were enrolled far longer - sometimes for several years - than the required life expectancy of six months or less,” according to the U.S. Attorney’s Office.
In one case, Passages billed Medicare for more than four years of elevated hospice care for a patient identified as “LJ,” according to the complaint. The patient’s son told investigators that his mother appeared in no danger of dying until the last month of her life, according to prosecutors.
According to data cited in the charges, Passages submitted claims from January 2006 to late 2011 for more than 4,700 patients to Medicare or Medicaid and was paid more than $125 million from the government programs. About 22 percent of Passages’ patients in that same time period had more than six months of hospice care, with 28 patients receiving more than 1,000 days of hospice care, according to the charges.
Gillman was also accused of using the windfall to paying elaborate bonuses to supervisors based on the amount of general inpatient care they oversaw. From March 2009 to April 2011, Gillman also paid himself bonuses of more than $830,000, prosecutors alleged.
The former clinical director for Passages told agents that Gillman said if a patient was under Passages’ care, they were sick enough to warrant the elevated care, according to the complaint. When the clinical director confronted Gillman over the eligibility of one particular patient, Gillman told her to “mind her own business” because he needed the money, the charges alleged.
jmeisner@tribune.com
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