CHICAGO _ His hands trembled at first. Then his vision blurred. Finally, unable to control a malignant blood pressure condition, Tinley Park cardiac surgeon Banio Koroma lost his malpractice insurance, then his operating room privileges and finally his professional standing.
Fortunately, he lived in Illinois, where medical regulation has been so lax even the most desperate of doctors can find financial reward.
Koroma took refuge in home health care, a lucrative and growing industry rife with fraud and tainted by unscrupulous physicians who travel to patients' homes in search of profit, then bleed money from taxpayer-financed programs.
The down-on-his-luck doctor took advantage of this loosely regulated world to exploit his patients and command a central role in a multimillion-dollar taxpayer swindle that breached the homes of 15,600 older adults getting services from a Chicago company called Mobile Doctors.
For adults hobbled by disability or disease who want to stay out of nursing homes or hospitals, home health care services can be a godsend.
For criminals who want to tap into federal Medicare dollars, it can represent a loosely guarded bank vault.
A Tribune investigation reveals that Illinois public health regulators proved unprepared for a surge in new home health care companies, doling out too many home health licenses too fast and failing to provide meaningful oversight.
Even today, most anyone can own a home health care business for a $25 license fee _ no criminal background check required.
Consequently, the Chicago metropolitan area is a hot spot for fraud, deemed among the most corrupt regions nationally. In the last five years, federal investigators estimate, area home-health agencies have improperly collected at least $104 million of public dollars.
Many home health companies operate lawfully and in the best interests of their customers. But fraud is so pervasive throughout the industry, federal officials say, that for every conviction like Koroma's, there are many other participants who are able to skate away.
As a result, already-vulnerable patients are put at risk.
Corrupt home health companies and complicit physicians as well as nurses secretly laced medical files with false diagnoses involving tens of thousands of Chicago-area patients, the Chicago Tribune found.
An analysis of federal court and enforcement files since 2012 shows that thousands of patients have been subjected to unwarranted procedures, therapies and tests; some were prescribed unneeded and powerful drugs.
Most victims were unaware that their medical histories were hijacked by swindlers _ there is no legal requirement to notify or warn patients when fraud is uncovered, or when providers are convicted of crimes.
Case files show that a disabled man in his 80s was denied a wheelchair by a government insurance program because a Chicago-area business had falsely purchased one in the man's name and then illegally pocketed the reimbursement check, according to AgeOptions in Oak Park, a federally funded advocacy group.
In another case, a hospitalized man was denied a transfer to a Chicago rehabilitation center because a home health company had fraudulently billed the government for nonexistent convalescent care.
"These scammers are really smart," said Jason Echols, statewide director for a senior Medicare program at AgeOptions. "Anybody could be a victim."
Sometimes, financial crimes jeopardize patients' lives.
Debra Lingelbach, a 48-year-old mother from Rockford, suffered inexplicable chest pain. "My chest was hurting all the time," she recounted in a video deposition involving a civil case. "Like someone was stabbing me in the chest."
Yet her traveling physician, Charles DeHaan, declared that her lungs "sounded fine," she said. DeHaan was part owner of a physician staffing company, which was exempt from public health licensing and oversight.
DeHaan pleaded guilty this year to two counts of felony health care fraud related to collecting $1.5 million for bogus examinations and inflated billings, federal court records show. Sentenced to 10 years in federal prison, he faces pending state charges, unrelated to Lingelbach, that involve accusations of sexual assaults involving multiple patients.
Three months after DeHaan's arrest, civil court records show, Lingelbach was examined by a new physician who delivered a devastating diagnosis: advanced-stage lung cancer.
She died months later.
