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Illinois Medical License Defense Attorney for Insurance Fraud Claims

Chicago professional license defense attorney for healthcare fraud claims

Chicago Lawyers for IDFPR License Discipline Based on Record-Keeping Irregularities

For physicians, surgeons, psychiatrists, osteopaths, and other doctors, a valid medical license is required to practice in the state of Illinois. Unfortunately, certain issues can threaten a license, including claims of insurance fraud or failure to maintain proper records. If you are facing discipline as a result of these types of issues, you should consult with an experienced attorney to determine how to defend your professional license against suspension, revocation, or other forms of disciplinary action.

With more than 55 years of combined legal experience, the lawyers of Williams & Nickl, LLC are uniquely suited to provide licensed professionals with a strong defense in cases before the Illinois Department of Financial and Professional Regulation (IDFPR). Attorney Edward W. Williams formerly served as the IDFPR's Chief of Prosecutions, and he and Attorney Fred Nickl have represented more than 3,000 clients throughout the state of Illinois. With our knowledge of the laws and experience with the rules and procedures followed by the IDFPR, we can work with you to minimize discipline to your license to the fullest possible extent.

Billing and Record-Keeping Issues

A medical provider may face discipline by the Illinois Medical Board if they engage in any conduct likely to defraud the public, obtain a fee for services through fraud or deceit, or overcharge for services in a "gross and willful and continued" manner. Some forms of insurance fraud that could result in disciplinary action include:

  • Billing for services that were not actually provided.
  • Providing medically unnecessary services in order to increase the amount billed to an insurance company.
  • Falsifying a diagnosis in order to bill for unnecessary tests or procedures.
  • Misrepresenting a procedure that was performed in order to bill an insurance company for a service that is not covered by a patient's insurance plan.
  • "Upcoding," or billing an insurance company for a more complex service than what was actually provided.
  • "Unbundling," or billing separately for multiple procedures that should have been grouped together as a single service.

In addition to facing discipline such as the suspension or revocation of a medical license, a person who commits insurance fraud may have their contracts terminated with insurance companies, they may be excluded from providing care to patients through Medicare or Medicaid, and they may face criminal charges for committing healthcare fraud.

In some cases, claims of insurance fraud may be disproved, and a provider may be able to explain any irregularities in record-keeping and avoid criminal charges. However, a doctor may still face disciplinary action if they do not establish and maintain proper patient records or if they violate the confidentiality of patients, either purposely or through negligence.

Our attorneys have assisted numerous clients who were facing discipline related to alleged fraud or record-keeping irregularities. In one successful case, we represented a surgeon who was accused of multiple violations, including failure to maintain patient records. We were able to obtain a simple probation order on the surgeon's medical license, and we were then able to restore the license to fully unencumbered status. We also successfully appealed actions by third-party insurers to terminate the surgeon's participation in their programs.

Contact a Chicago IDFPR Discipline Defense Attorney

Accusations of insurance fraud can be very serious for any medical provider. These types of claims should be addressed immediately to ensure that you will be able to continue practicing and maintain your contracts with insurance companies. Our attorneys can review your records and help you determine your best strategy for defending your medical license. We will work to provide credible explanations to the IDFPR for any irregularities and help you avoid or minimize the public discipline that you may face. To schedule a complimentary one-hour consultation with Edward and Fred and learn how we can help you maintain a valid medical license, contact us today by calling 312-335-9470.

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