Horizons Hospice / 365 Hospice: Patients Stayed Stable, the Charts Changed

In the Horizons Hospice 365 settlement, the company, now called 365 Hospice, and its owner agreed to pay $1.24 million to resolve allegations of billing Medicare and Medicaid for ineligible patients and falsifying the records behind those claims. The whistleblowers’ complaint described the alleged mechanics inside the business: patients whose weight stayed steady or increased, and records allegedly changed to make them appear to be declining. In that account, the person weighing the patient and the person reading the finished chart saw different stories.

What the Horizons Hospice Settlement Resolved

The privately owned, for-profit health care provider and its owner and chief executive reached the settlement announced by the Justice Department on February 8, 2018.

The agreement resolved two qui tam cases filed in federal court in Pittsburgh. The government’s account of the settled claims covered June 27, 2007 through August 1, 2012: patients allegedly lacked a life expectancy prognosis of six months or less, yet the company billed for hospice services and falsified supporting records. The announced payment covered the company and its owner together.

The hospice fraud allegations describe taxpayers paying for end-of-life care on the strength of invented decline. The complaint gives an insider a closer view of how the records allegedly came to say what the company needed them to say.

Admissions and Recertifications Built on Changed Weights

The whistleblowers alleged that false certification and recertification kept stable, nonterminal patients receiving hospice care for years. The whistleblowers’ complaint described their own work weighing patients. When patients maintained or gained weight, hospice representatives allegedly changed the recorded weights to make those patients appear to be declining and appropriate for hospice.

That is a concrete account of hospice eligibility fraud: a measurement taken from the patient allegedly became a different measurement in the chart. The people doing the weighing could explain a discrepancy that someone reviewing only the finished record would never see.

The payment system gives those repeated certifications financial importance. Medicare pays for each enrolled day, including days without a visit. A hospice can keep receiving payment through a long stretch of relatively little care. The HHS Office of Inspector General examined that incentive in its 2015 study of assisted-living hospice care, Medicare Hospices Have Financial Incentives to Provide Care in Assisted Living Facilities:

The study found longer stays and higher payments for beneficiaries in assisted living than in other settings, often with diagnoses requiring less complex care. Its findings explain the industry’s incentive. The Horizons complaint supplies the provider-specific allegation: recorded observations allegedly changed on paper to keep patients eligible.

What Happens If a Hospice Patient Lives Longer Than Six Months?

Continued hospice coverage requires a physician to recertify that the patient has a terminal illness with a life expectancy of six months or less. Under the Medicare hospice coverage requirements, the physician’s narrative must reflect the patient’s individual clinical circumstances.

The Horizons allegation concerns what went into that judgment: observations put into the patient’s record were allegedly changed. The weight someone actually measured matters because the certification depends on an account of the patient’s condition.

Physician Signatures and Charts Prepared for Inspection

The complaint alleged routine forgery of physician signatures on patient-care records, including assessments, certifications and recertifications. It described a hospice doctor vacationing in India whose name was signed and initialed on multiple patient records while he was away.

The whistleblowers also alleged that Horizons altered patient records and forged signatures in anticipation of state regulator visits. They described offices closing while records were destroyed:

In that account, the approaching inspection became a reason to change the evidence of care.

Free Equipment Tied to Patient Referrals

The complaint’s hospice referral kickback allegations followed equipment into nursing homes. The whistleblowers alleged that Horizons worked with Punxsy Medical Supply, doing business as Rezk Medical Supply, to provide free equipment and supplies in exchange for patients.

One example involved beds, wheelchairs and gel packs delivered to a nursing home. A whistleblower described being there for the delivery and helping store equipment in the basement. When the home changed directors and switched hospice providers, the defendants allegedly demanded the equipment back. According to the complaint, they did not get it.

The demand for its return gave the alleged donation a very different meaning. In the whistleblowers’ account, keeping the equipment was tied to keeping the hospice referrals. A delivery that looked like generosity to the home allegedly helped buy access to its patients.

The complaint also alleged that the supplier failed to credit Medicare and Medicaid for equipment returned after patients were discharged or died. That creates a separate billing trail: what was delivered, what came back, and what happened to the payment.

The Corporate Integrity Agreement Bound the Owner Too

The compliance agreement named both 365 Hospice and its owner and chief executive. The HHS Office of Inspector General’s entry lists a five-year corporate integrity agreement, effective from February 8, 2018 to May 3, 2023.

The compliance obligation reached the owner personally.

What Evidence Is Needed to Prove Fraud?

For allegations like those at Horizons, the evidence connects what staff observed about a patient, what the certification said, and what the hospice billed. We examine those connections with the insider who knows how the records were created. A changed weight, a signature supplied during a doctor’s absence, or charts altered before an inspection each tells a different part of that story.

The same attention to the underlying record appears in the HHS Office of Inspector General’s June 2026 audit of certain new hospice enrollees. Of 100 initial certification periods reviewed, 45 failed Medicare requirements. The audit focused on new enrollees without inpatient or emergency-room claims during the preceding 18 months.

For the equipment allegations, the connection runs from a delivery or return to the referral relationship and the payer’s account. In this complaint, someone who helped put equipment in a basement could describe the transaction from inside it. We bring that firsthand account together with the records showing what the transaction bought.

Hospice Fraud Cases and Whistleblower Rewards

The pattern extends beyond Horizons. In the 2024 Kindred settlement, involving Gentiva as successor to Kindred at Home, the allegations included ineligible patients, retained overpayments and a separately disclosed physician-referral arrangement. Patient selection, payment records and referral relationships can meet in the same healthcare fraud case.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Saw the Patient Before the Chart Changed

If you know how patient observations became different numbers in a chart, or why equipment followed a referral, speak with our whistleblower experts. We work with you to build your strongest hospice whistleblower case around what you saw, bring in hospice fraud whistleblower lawyers who understand certification and referral schemes, and stay beside you through the pursuit of a recovery.