Sometimes we hear about stories that are not just unlawful and unethical, but ones that make us sick to our stomach. This is one of those stories.
It depicts the life of an Illinois businessman whose healthcare company is thriving, but the source of his success is criminal. When a nurse finally stood up to him, his company was in serious need of life support…
2012 was the biggest year yet for businessman Seth Gillman. Gillman operates a Hospice company called Passages, which is the largest in Illinois. On November 29, 2012, the Better Business Bureau of Chicago honored Gillman for the compassion he brings to the industry.
What Inspired Him
During his speech, Gillman shared that he was inspired to started Passages after his grandmother went to a hospice herself. He said that at Passages, his patients are treated with the utmost respect, as it’s his core value. Nurse Karen Wilson, former Passages Clinical Director said that Gillman is the type of man who always got what he wanted and what he wanted was more money…
Unusual Increase In Hospice Patients
While working at Passages, Karen noticed a steady incline in the number of patients at Passages going from 30 to 300 in just two years. According to Gillman, he told his staff that he was changing the course of his business because he was tired of not making money. He didn’t think that 200-300 patients was enough so to increase Passages revenue from Medicare, Gillman played fast and loose with how patients were categorized.
GIP Is Where The Money Is
He wanted as many hospice patients as possible enrolled in what’s called General Inpatient Care (GIP). Apparently, it’s where the money is. For routine hospice services, Medicare pays around $130 per patient per day. But, for GIP, it’s four times that amount, totaling $550 per patient per day…
He Needed More Patients On GIP
But since there were a large number of patients at Passages who weren’t at the end of their life and weren’t really suffering conditions that Medicare was paying for, Gillman needed a way to keep them there. He enlisted his staff to help with his elaborate scheme.
Gillman hired marketers to go out and try to recruit patients and nurses who would be trained to make patients seem “more dying” than they were. One example was when he had nurses re-work patients’ medical charts to make a bruise look like a life-threatening illness. Some patients were diagnosed as dying from cancer when they didn’t have cancer at all…
Journalist Got Wind Of Criminal Activity At Passages
In 2014, a journalist who writes about end-of-life issues began to investigate Gillman and Passages. He learned that a woman who was a patient there was told that she was dying when she wasn’t really. She was put on hospice care and her family even made funeral arrangements thinking that she was going to die in just a few weeks.
Besides that one woman, Gillman had patients who were on hospice for three to five years, something that was absolutely unheard of. Over a four year period, Passages billed Medicare $95,000,000 and Gillman pocketed almost $2 million in one year alone…
As his business expanded, so did his wardrobe. Nurse Karen recounted that Gillman would go to Paris just to buy his clothing and come to the hospice and brag about it. He also spent his money on his fancy car collection. Gillman was raking in millions, but he didn’t just keep the money all for himself.
If his employees played along, Gillman would reward them financially. From March through December 2010, one employee earned over $112,000 in bonuses! Another staff member, eager to earn more cash emailed Gillman saying, “Let’s go ‘balls out’ with GIPS tomorrow. I need a lot of extra $- need to pay my mom’s house for next few months to get them back on track. I’m gonna find two a day- don’t care if I go out till 10 pm.”
Employees had a huge financial incentive to make sure that more patients were put on GIP and to keep patients on GIP more than was legitimate. The higher-ups at Passages ultimately took advantage of people who were trying to do good work and because of his abrasiveness, many people did not like Gillman.
Collecting The Evidence
While working at Passages, Nurse Karen realized that Gillman was running a massive fraud scheme so she quit and walked out the door for good. But she didn’t leave without taking a few files, ones that would later pay off. Karen had every intention of turning the files in for Medicare fraud and she knew she needed the evidence to prove that what she was saying was true…
Proof Of What Gillman Was Really Doing
Wilson knew there were computer records and that at any moment, they could be changed, so she copied the records. Meanwhile, in 2009, Medicare noticed a steep increase in the amount of money it paid Passages and an audit was ordered in response. Gillman knew he would have to pay Medicare back if he couldn’t justify the invoices, so he decided to ask staff to alter patient charts to make them appear as if all the GIP patients were legit.
Altering Medical Records
But since Karen Wilson handed the records over to authorities, they were able to very clearly see how the records were altered. If Passages had just simply accepted they made a mistake and agreed to pay Medicare back, things would not have progressed the way they did. But that’s not what happened…
Behind the scenes, authorities interviewed Wilson and other former Passages employees. Special Agent Karl Kraywinkle was the lead investigator for the FBI and said that Wilson proved herself to be “invaluable” to the case.
In February 2012, the FBI executed a search warrant on the headquarters of Passages in Illinois. The FBI was able to get their hands on payroll documents that clearly showed when an employee at Passages would get a bonus or raise. Then, they compared that to how long a patient was on GIP for, and the numbers showed the connection between the GIP and the huge bonuses employees were getting…
A Fancy Party While His Patients Were Dying
Yet, despite the search, Gillman appeared to be unfazed. The next year he organized a celebration to announce the new initiatives in Hospice care. During the party, hospice nurses danced in scrubs and it seemed ironic to throw a fancy party while hospice patients were reportedly dying.
Finally in January 2014, thanks to Wilson, Seth Gillman was indicted on 16 counts of health care fraud. He eventually pled guilty to one count of health care fraud and another of obstructing a federal audit and agreed to pay restitution of $9 million…
At his sentencing, Gillman told the judge, “I betrayed the trust of Medicare… I was stupid and I was wrong.” At the sentencing hearing, the judge said, “There’s nothing that drove this other than greed.” Then on March 7, 2017, Gillman was sentenced to six and a half years in prison. Six employees who worked for Gillman were also convicted are serving sentences from 2 years probation to five years in jail. While his employees may not have done this, they participated and have to bear the punishment as well.
Nurse Wilson now owns and operates a small hospice business with her daughter. She says she has about 30 patients and is not getting rich. As far as what she witnessed while working for Seth Gillman, Wilson says, “It is a stark reminder to never put profits before patients.” She says that it all comes down to plain greed.