August 12, 2013 – Fraudsters nationwide are taking advantage of our tax dollars by submitting false claims for Medicare’s hospice care benefit. The Department of Justice (“DOJ”) is fighting back, settling two recent cases – one against a small not-for-profit hospice provider, Hernando-Pasco Hospice, Inc., resulting in a $1 million recovery and another against Hospice of Arizona, L.C., yielding a $12 million recovery.
August 12, 2013 – Fraudsters nationwide are taking advantage of our tax dollars by submitting false claims for Medicare’s hospice care benefit. The Department of Justice (“DOJ”) is fighting back, settling two recent cases – one against a small not-for-profit hospice provider, Hernando-Pasco Hospice, Inc., resulting in a $1 million recovery and another against Hospice of Arizona, L.C., yielding a $12 million recovery. In addition, this past May, the DOJ filed a False Claims Act Complaint against the largest for-profit hospice chain in the country, Vitas Hospice Services LLC, a subsidiary of Chemed Corporation, based in Cincinnati, Ohio. The False Claims Act case against Vitas seeks the recovery of tens of millions of dollars plus treble damages. All three cases were originally filed by whistleblowers under the qui tam provisions of the False Claims Act.
Hospice care is palliative treatment provided to terminal cancer patients in their last few months of life. To receive Medicare’s hospice benefit, a patient must agree to forego further medical treatment of his disease and allow it to run its normal course.
Hospice care is paid for by Medicare at different levels. In addition to palliative care, continuous home care, also known as “crisis care,” is available to patients who are experiencing acute medical symptoms which result in a brief period of crisis requiring skilled nursing services on a short-term basis. It differs from the standard hospice benefit which does not require skilled care. Crisis care allows the patient to receive more emergent care in the comfort of his home. Due to its nature, crisis care is the most expensive hospice benefit provided by Medicare.
In the case against Vitas, the Government has alleged that Vitas knowingly submitted false claims to Medicare for crisis care services that were not necessary, not actually provided, or not performed in accordance with Medicare requirements. According to the Government’s Complaint, some of the egregious acts committed by Vitas include billing Medicare for one “crisis care” patient whose medical records indicated that she was playing bingo at the time and another patient who was noted to be “very healthy given her age.”
In the cases of Hospice of Arizona and Tampa-based Hernando-Pasco Hospice, the false claims emanated from the hospice providers’ submission of claims for patients who were ineligible or no longer appropriate for hospice care. Both providers actively pressured staff to find patients to enroll and to meet targets. They also delayed discharging patients from hospice and instructed staff to write false and misleading progress notes in order to keep patients on hospice longer than medically necessary.
Medicare’s hospice benefit is designed to serve a vulnerable population of the terminal, cancer-stricken patients. Providers who doctor notes and submit false claims not only take advantage of our tax dollars but also of the already weakened cancer sufferers. In each of the cases described above, individuals employed by the defendants came forward and reported fraud putting an end to the wrongful schemes.
If you are aware of hospice fraud, contact the whistleblower attorneys at Levy Konigsberg LLP for a free consultation. You may be eligible for an award if your case is successful.
IMPORTANT: If you believe you have evidence of fraud against the government, securities fraud, commodities fraud, or IRS or New York State tax fraud, contact us for a free, confidential consultation by calling our 24/7 toll-free hotline at 1-800-988-8005 or by submitting an email inquiry (see form above).