Hospice Nurse Impersonation: One Stolen Identity, Eight Employers

The Dallas-Fort Worth hospice nurse impersonation case involved an unlicensed worker who used a registered nurse’s stolen identity to obtain work at eight hospice companies. According to the Department of Justice, she submitted documents falsely attributing patient care to the nurse whose identity she had stolen. The hospice fraud reached from the hiring file to the bedside to Medicare and Medicaid claims. An employee who knew who actually cared for a patient could see something the paperwork concealed.

A Stolen Identity Became a Nursing Record

The worker used a registered nurse’s driver’s license, Social Security number and other identification to obtain hospice employment. The Justice Department’s December 2014 account says she had no license as a physician, registered nurse or other health care provider.

At Heart to Heart Hospice of Texas and Odyssey Healthcare GP, LLC, she obtained work as a registered nurse and had direct responsibility for patient care. The documents she submitted to those employers falsely indicated that a registered nurse had provided care to patients under her supervision. The professional identity on those documents belonged to the person whose identification she had stolen.

The other affected employers named by the government were Community Hospice of Texas, Elysian Hospice, Hospice Pharmacy Solutions, New Century Hospice, Keystone Custom Care Hospice and Silverado Senior Living Hospice. Each appears in the government’s account as an employer where she used the stolen identity to obtain work.

The false name traveled with the care. The Justice Department said her false statements caused Heart to Heart, Odyssey and other hospice agencies to submit false claims and obtain reimbursement from Medicare and Medicaid.

The Patients Behind the Paperwork

The government reported that the impersonator saw and purportedly treated 243 hospice patients. Its August 2015 account describes patients who were mentally ill, comatose, asleep or otherwise unresponsive to sound and touch. She made assessments of their pain, comfort, digestive function and breathing.

Those assessments concerned people who could be unable to describe what they were experiencing. Patients depended on qualified care, and taxpayers paid for it. A stolen identity had taken the place of the qualification.

Her work also reached hospice admissions, where the focus changes from curative treatment to end-of-life palliative care. The government described access to patient charts and detailed personal information, as well as conversations with nursing home staff and patients’ family members. The stolen identity opened more than an employment file. It put the impersonator inside the patient’s care and private life.

Why the Identity Mattered to Hospice Payment

Medicare pays a hospice a daily rate for an enrolled patient, including days when staff make no visit. The provider takes responsibility for care relating to the terminal illness and related conditions. That payment structure puts the clinical record at the center of the story: who assessed the patient, what care was needed and who provided it.

The care team uses a patient-specific assessment to prepare a written plan of care. Licensed professional services must come from appropriately qualified professionals, as the Department of Health and Human Services’ Office of Inspector General explains in its review of hospice care requirements. Here, an unlicensed worker made the assessments and submitted care documents under a nurse’s stolen identity.

The connection to hospice billing fraud was explicit here. The government tied the worker’s false care documents to claims submitted by her employers. A coworker, care manager or billing employee who knows who did the work can explain the mismatch.

Credential Checks Protect the Patient Record

The Inspector General’s July 2019 report, Hospice Deficiencies Pose Risks to Medicare Beneficiaries, found that failures to vet staff and inadequate quality control could jeopardize patient safety. In its review of selected serious deficiencies, it described the scale of one hospice’s credential problem:

The finding shows why a credential file deserves attention alongside the patient chart. The chart represents professional work, and the credential file helps establish who was qualified to perform it.

The Inspector General also found inadequate patient assessments, including failures to assess pain or keep assessments current. It explained that the assessment dictates the care a beneficiary receives. In the Dallas-Fort Worth case, the government’s account put an unlicensed worker in that assessment role. The problem reached the care decisions as well as the name on the page.

Medicare Claims Under a Stolen Nurse Identity

The Justice Department’s December 9, 2014 announcement described approximately $2.3 million in Medicare hospice claims for services purportedly performed under the stolen identity. Its August 24, 2015 announcement put those claims at approximately $800,000, alongside approximately $107,000 in compensation to the impersonator from the hospice agencies.

Both announcements cover approximately January 2009 through April 20, 2012, without explaining the difference in claims totals.

What Evidence Is Needed to Prove Fraud?

In a nurse-impersonation case, the proof ties together the identity used to obtain employment, the care attributed to that identity and the government claims that followed. We work with insiders to connect those records to the people who created, used or approved them.

The hiring file, care assignments, patient notes and billing records tell different parts of that story. Our whistleblower experts examine where the paperwork and the care diverged, and who inside the business knew it.

An admissions employee may recognize a person whose identity appears on an intake record. A nurse or care manager may know who actually assessed the patient. A billing employee may see the documents used to support payment. Our work is to bring those views together around particular patients and claims, with the insider’s account of what happened inside the hospice.

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

You Know Who Was at the Bedside

If you know a hospice used the wrong professional identity in its patient records, speak to one of our whistleblower experts about who was really at the bedside. We build the case with you around the care, the claims and the decisions behind them, and bring in hospice fraud whistleblower lawyers who understand nursing records and Medicare billing. We stay with you from the first call, bringing our experience to the decisions that turn your knowledge into your strongest hospice whistleblower case.