Lincolnwood resident, attorney, and businessman Seth Gillman, has been charged with health care fraud. Gillman owns one-quarter of Passages Hospice LLC, and is named the administrator of the company. He is also the agent and secretary of Asta Healthcare Company, Inc., an entity that manages Asta Care Center nursing homes in several cities in Illinois, including Bloomington, Colfax, Elgin, Ford County, Pontiac, Rockford, and Toluca.
According to the Daily Herald, “Prosecutors said . . . Gillman . . . obtained higher Medicare and Medicaid payments by fraudulently elevating the level of hospice care for patients.” In addition, Gillman did not apparently act alone, as court documents indicate that he was aided by medical directors under his watch.
Gillman was charged with one count each of health care fraud and of obstructing a federal audit, serious charges if he is found guilty and convicted.
Health Care Fraud in Illinois
Passages itself has no inpatient facilities, but had hired nurse to tend to hospice patients in various nursing homes and those who were in need of homebound treatment. Passages grew and eventually split its operations geographically and by region, covering Chicago and the Chicagoland’s western suburbs, including Rockford, Bloomington, and Belleville. Along with its expansion, naturally, this meant an increase in nursing staff, nursing directors, and medical directors to cover each regional area.
How did Gillman elevate the level of hospice care for patients? Apparently, between August 2008 and January 2012, Gillman specifically trained Passages nurses to look for certain “signs” that would make hospice patient qualify for general inpatient care (GIP). As a result, the payments for the patient’s care would be higher than that of just routine care. Gillman was fully aware, according to the allegations, that a majority of the Passages’ patients were being incorrectly placed on GIP.
And how much higher was the reimbursement for one patient? For fiscal year 2012, Medicare’s daily reimbursement for GIP was $671.84, whereas daily payment for routine care was $151.23.
Records from the court record indicate that Passages submitted claims for Medicare and Medicaid between 2006 through 2011 for close to 4,800, and that the company was paid approximately $95 million in Medicare reimbursements and $30 million from Medicaid.
Another article noted the following account:
“A woman, identified as Individual E in the affidavit, who helped Gillman and his father start Passages and served as its clinical director for several years until she was fired, told agents that Gillman said if a patient was under Passages’ care, they were sick enough to warrant GIP care. When Individual E confronted Gillman over the GIP eligibility of Patient DB, Gillman allegedly told her to mind her own business because he needed the money, the affidavit states.
Gillman is also accused of awarding himself bonuses and also divvying out bonuses to regional directors.”
The criminal complaint was filed on January 24, 2014 in U.S. District Court. Gillman appeared Wednesday, January 29th, at 3 p.m. before Magistrate Judge Geraldine Soat Brown in Federal Court.
If Gillman is convicted, he faces up to 10 years in prison and $250,000 in fines. As one piece of course indicated, Gillman is innocent until proven guilty.
Health care fraud is entirely unacceptable in all its forms. It demeans patients, unjustly enriches the perpetrators, and damages care for all taxpayers who see funding drained unnecessarily. It you were affected by health care fraud in any form, please contact our attorneys today to see how we can help ensure accountability.