In the past 20 years or so, there has been a concerted effort by the federal government to crack down on the number of fraudulent claims that are submitted to Medicare by medical providers. One of the ways that the government prevents fraudulent claims is through prepayment audits. If your practice has been notified that you are the subject of a prepayment audit, you should contact an Illinois professional license defense attorney for legal assistance.

Zone Program Integrity Contactors

Prepaid audits fall under the bailiwick of the Centers for Medicare and Medicaid Services. The agency often employs Zone Program Integrity Contactors (ZPICS) to conduct these investigations into potential waste, abuse, and fraud. In some cases, ZPICS will use methods to mine the practices’ algorithms in an attempt to see if they can find any abnormalities in billing which could indicate fraud is taking place.

Issues That Can Result in a Prepayment Audit

There are certain issues that can result in ZPICS knocking at your door or a denial of claims:

No matter where you are in life or what your profession is, anyone can find themselves dealing with some kind of legal issue, whether it has to do with being charged with a DUI, stealing medications, fraud, or domestic violence. While these criminal accusations are serious for any individual, they can have even more dire consequences for an individual who holds a professional license. If you are a licensed professional in the state of Illinois and have concerns or questions regarding what you are required to notify the licensing board that oversees your profession, you should speak with an Illinois professional license defense attorney.

What Charges Need to Be Disclosed?

When a person who holds a professional license is charged with a crime, one of the first factors that need to be examined is whether the crime is related in any way to their profession. In the case of a medical professional stealing prescription medications from patients, that relation is pretty clear. There are other charges that are not so clear. For example, if a doctor is arrested for drunk driving, they may not feel this is something they need to report because it was not connected to their position.

However, the Illinois Medical Board may feel differently. When a person is arrested for DUI, it can sometimes indicate an alcohol problem. Although not every person arrested for drunk driving is an alcoholic, the board will likely initiate an investigation to determine if there is evidence of an alcohol problem – something that could be very dangerous for the patients the doctor is treating.

In Illinois, there are a number of different professional licensing boards that all fall under the umbrella of the Illinois Department of Financial and Professional Regulation (IDFPR). Any individual who holds a professional license in the state of Illinois is under the oversight of whatever board issued that license. When there is a complaint or other issue filed against an individual, that board will be the one to investigate the complaint, determine if there is validity to it, and decide if any disciplinary action should be taken against the person who holds that license.

Anyone who has been notified that they are under investigation should contact an Illinois professional license defense attorney right away in order to ensure their rights are protected in any investigation and/or hearings that take place. Choosing the right attorney, however, is critical.

Hiring a Professional License Defense Attorney

There are a number of boards that fall under the IDFPR, including:

The real estate market is booming across Illinois and across the country. For sale signs that are put up in front of homes are quickly replaced with under contract and sold signs. Many real estate agents are having great success in sales and the commissions they are earning. However, all it takes is one complaint or one investigation by the Illinois Division of Real Estate (DRE) and that success can quickly disappear.

Without a real estate license, a person cannot sell real estate in the state. The DRE has established standards that all Illinois real estate professionals must adhere to. Accusations of not following those standards could result in loss of your license. So, what types of issues could threaten an agent’s real estate license?

Criminal Conviction

One of the most serious issues that can result in loss of a real estate license is a conviction for certain crimes, especially crimes of moral turpitude. Crimes that fall in this category include the following:

In today’s litigious society, doctors often have to worry about medical malpractice claims. The high cost of malpractice insurance to protect a physician and their practice is one of the factors that drives the high cost of healthcare. Although focused on malpractice concerns, worrying about accusations for Medicare or Medicaid fraud is not something that a physician usually concerns themselves with, yet these accusations occur much more often than you may realize.

Medicare Fraud Accusations

The False Claims Act was enacted to protect these programs from the filing of false claims. A physician can be accused of fraud for false claims if the Office of Inspector General (OIG) feels that physician knew or should have known the claims were not valid. Under this law, a physician can be held legally liable even if they had no idea their office was submitting fraudulent claims with Medicare or Medicaid. If the OIG finds the physician guilty, that physician can receive a fine of $11,000 for every incorrect or fraudulent item billed to the government.

Incorrect coding is also another reason why the OIG may accuse a doctor of Medicaid fraud. If the incorrect code results in a larger amount of reimbursement than what the actual charge should have been, the OIG could deem this act an abuse of the program.