Sunday, April 24, 2016

For the record - it took awhile

For the record - it took awhile, but reluctantly proceedings are now pending against Seth Gillman.    The complaint reads:

In the Matter of:
Commission No. 2016PR00034
FILED --- April 11, 2016
Jerome Larkin, Administrator of the Attorney Registration and Disciplinary Commission, by his attorney, Scott Renfroe, pursuant to Supreme Court Rule 753(b), complains of Respondent Seth Gillman, who was licensed to practice law in Illinois on November 4, 1993, and alleges that Respondent has engaged in the following conduct that subjects him to discipline pursuant to Supreme Court Rule 770:
(Plea of Guilty to Health Care Fraud)
1.    On May 22, 2014, a grand jury in the United States District Court for the Northern District of Illinois returned an 18-count indictment against Respondent, three other individuals and Passages Hospice, LLC ("Passages"). The indictment identified Respondent as the founder, co-administrator and co-owner of Passages, and charged him with engaging in multiple instances of health care fraud (Counts 1 through 16) and with conspiring to obstruct a federal audit (Count 18), in violation of Title 18, United States Code, Sections 1516 and 371.
2. On February 12, 2016, Respondent, his counsel, and the United States Attorney for the Northern District of Illinois entered into a plea agreement by which Respondent pled guilty to the offense of health care fraud, in violation of Title 18, United States Code, Section 1347, as originally charged in Count 5 of the indictment.
3. As part of the plea agreement, Respondent stipulated that there was a factual basis for his guilty plea, and that those facts established his guilt of the offense beyond a reasonable doubt. Specifically, Respondent admitted to the facts and conclusions set forth in the following paragraphs.
4. Beginning in 2008 and continuing through 2011, Respondent and others participated in a scheme to cause Passages to submit false claims to Medicare and Medicaid for medically unnecessary hospice care for patients who were not terminally ill, and hospice care that did not qualify for general inpatient services. Respondent submitted claims to a federal contractor and the Illinois Department of Healthcare and Family Services for services that were not medically necessary or were not provided.
5. Respondent knew that Passages regularly billed Medicare and Medicaid for general inpatient services even though he knew that Passages used improper criteria that did not comply with Medicare and Medicaid requirements, and that many of those services were not medically necessary. Respondent and a co-defendant designed and implemented a system at Passages in which bonuses were paid to nursing directors and certified-nursing directors based on the number of patients that were placed on general inpatient care each day. Respondent knew that theses bonuses were not compensation for any additional nursing services, and that the bonuses were designed to be an incentive to put patients on unnecessary general inpatient care.
6. Respondent made decisions at times to put patients on general inpatient care so that Passages could make more money, even when he had no knowledge about the condition of the patient and even though he was not a physician or nurse.
7. In August 2009, Respondent learned that TrustSolutions, which performed audits on behalf of Medicare, had requested patient files, and that two of his co-defendants were directing the alteration of the requested patient files before the files were provided to TrustSolutions. In particular, Respondent knew that some of the files did not contain signed orders from physicians regarding general inpatient care and did not contain nursing notes consistent with patients actually receiving that care, as had been billed. Respondent agreed with others that Passages employees should alter the files to make it falsely appear that the care was appropriately billed. When the alterations were completed in September 2009, Respondent signed letters attesting to the accuracy of the patient files and that the services had been properly billed. Respondent knew that his statements in such letters were not true because the files had been altered and because some of the services had not been properly billed. Respondent also knew that Passages nurses continued to improperly place patients on general inpatient care even after he received two reports regarding the inappropriate use of that level of care in August 2010.
8. By reason of the conduct described above, Respondent has engaged in the following misconduct:
a. committed a criminal act that reflects adversely on his honesty, trustworthiness or fitness as a lawyer in other respects, by committing the offense of health care fraud, in violation of Rule 8.4(a)(3) (1990) and Rule 8.4(b) (2010) of the Illinois Rules of Professional Conduct; and
b. conduct involving dishonesty, fraud, deceit or misrepresentation, participating in a scheme to charge Medicare and Medicaid for medically unnecessary inpatient hospice services, and by signing letters attesting to the authenticity of altered hospice files, in violation of Rule 8.4(a)(4) (1990) and Rule 8.4(c) of the Illinois Rules of Professional Conduct (2010).
WHEREFORE, the Administrator requests that this matter be assigned to a panel of the Hearing Board, that a hearing be held pursuant to Supreme Court Rule 753, and that the panel make findings of fact, conclusions of fact and law, and a recommendation for such discipline as is warranted.
Scott Renfroe
Counsel for Administrator
Attorney Registration & Disciplinary Commission
130 East Randolph Drive, Suite 1500
Chicago, Illinois 60601-6219
Telephone: (312) 565-2600
Respectfully submitted,
Jerome Larkin, Administrator
Attorney Registration and
Disciplinary Commission

By:  Scott Renfroe

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