Compassionate Care Hospice of New York: Nursing Notes for Visits That Never Happened

In the Compassionate Care Hospice New York settlement, the company agreed to pay $6 million to resolve allegations of missed nursing visits and falsified notes at its Bronx operation. The New York hospice accepted responsibility for failures in patient care and clinical records. Compassionate Care Hospice Group Ltd. accepted responsibility for insufficient oversight through its compliance audits. The failures reached from the patient’s care to the group charged with checking the work.

The Department of Justice announced the resolution on February 18, 2015, following approval in Manhattan federal court. The defendants were Compassionate Care Hospice of New York, LLC and Compassionate Care Hospice Group Ltd. A whistleblower brought the case, and the government joined it. This hospice fraud case concerned care that patients were supposed to receive and the records that said they had received it.

Missed Nursing Visits and Falsified Notes

The government’s complaint alleged that nurses routinely missed required visits between May 2010 and September 2011. Patients’ care plans typically called for a hospice nurse to visit one to three times per week. According to the Justice Department’s account, nurses then falsified notes to make the visits appear to have happened, at the direction of Bronx management and with the group’s knowledge.

A care plan called for a visit. The nurse did not make it. A note in the patient’s file said otherwise. The government alleged that the hospice nevertheless billed Medicare and Medicaid for services that had not been performed or had not met the programs’ requirements.

In that account, taxpayers paid for care patients did not receive. Patients lost the nursing visits their plans called for. The false note allegedly hid that loss inside the very file meant to describe the patient’s care. For a nurse who knew the patient or a supervisor who knew the schedule, the difference between the visit and the entry was something concrete.

The New York hospice expressly accepted responsibility for failing to follow individualized care plans, meet certain patients’ needs, make nursing services available around the clock and seven days a week, and maintain adequate clinical records. Those admissions describe failures in delivering care as well as failures in documenting it.

What the Group Accepted About Oversight

The group accepted responsibility for failing to provide sufficient oversight of the New York operation through its compliance audits. That puts the group’s review of the Bronx operation at the center of the case alongside the nursing work itself.

The allegation about knowledge and the accepted oversight failure describe different parts of the story. The government alleged that the group knew about the falsified notes. The group accepted responsibility for insufficient audit oversight. An insider working in compliance may therefore hold a different part of the account from a nurse: what the audits examined, what problems reached the group and how it responded.

Why the Care Plan Matters Under Daily Payment

Medicare’s daily hospice payment is intended to cover the services in the patient’s plan of care. Milliman’s 2019 report Hospice Medicare Margins, commissioned by the National Partnership for Hospice Innovation, explains that payment follows each enrolled day, regardless of the services provided on that particular day. Nursing care is among the services the hospice must make available.

That payment structure makes the care plan essential to understanding hospice billing fraud. The plan identifies what the patient needs. The visit record should show how the hospice met that need. In the Bronx case, the government alleged that fabricated notes made missing care appear complete while the hospice continued billing.

The wider industry has struggled with that gap between a written plan and delivered care. The Department of Health and Human Services’ Office of Inspector General’s July 2019 report, Hospice Deficiencies Pose Risks to Medicare Beneficiaries, found that care-planning deficiencies were among the most common problems in hospice surveys. One example from those surveys makes the gap plain:

The survey example shows why a plan can look complete while the patient goes without its promised care. The Bronx allegations add the deliberate creation of a record saying the missing visits occurred. A note can conceal the gap. It cannot supply the care.

Is Knowingly Billing for Services Not Provided an Example of Fraud?

Knowingly billing Medicare or Medicaid for services that were not provided is healthcare fraud. The New York settlement involved that allegation together with claims for nursing services that failed to meet program requirements. The connection was between the required care, the false clinical record and the government payment.

A similar service-delivery allegation appeared in the Justice Department’s case against Vitas. The government alleged that Vitas billed for continuous home care that was unnecessary, not actually provided or not delivered according to Medicare requirements. It also alleged goals for the number of continuous home care days billed and pressure on staff.

The cases concern different care requirements, but both put the same practical question in front of an insider: what care did the patient receive compared with what the provider claimed? The clinical work and the billing decision belong in the same account.

How the Federal and New York Payments Fit

The federal agreement required $4,992,000 payable to the United States. The state agreement required $1,008,000 payable to New York. The state agreement also provided for a whistleblower reward of 18% of New York’s recovery.

Five Years of Compliance Monitoring

The hospice and the group also entered a corporate integrity agreement with the Office of Inspector General, committing to institutional compliance measures and five years of monitoring. The agreement covered Compassionate Care Hospice Group Ltd. and Compassionate Care Hospice of New York, LLC.

In a case where the group accepted responsibility for inadequate compliance audits, oversight was part of the resolution as well as part of the failure.

The Same Brand Had Different Hospice Cases

In the separate Atlanta matter, the government alleged payments for physician referrals, including medical-director payments and sham associate medical-director contracts. Compassionate Care of Gwynedd, in Pennsylvania, separately settled allegations of admitting patients who did not need hospice using a medically unjustified debility diagnosis.

What Hospice Insiders Can See

A nurse may know which visits happened and which appeared only in the chart. A clinical supervisor may know who directed the entries. A compliance employee may know what the group learned through audits. Together, those perspectives connect the health care patients received, the account placed in the medical record and the company’s decisions.

For hospice fraud whistleblowers, the useful knowledge can be very specific: the patient’s care plan, the visit schedule, the nursing note and the instruction that made the note depart from what happened. That is where our whistleblower experts focus with you. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Whether the Visit Happened

If you saw nursing notes created for visits that never happened, speak to one of our whistleblower experts about the care and the instructions behind those entries. We bring in hospice fraud whistleblower lawyers who understand service-delivery claims and work beside you throughout the case, using your knowledge of the patients and the business to build your strongest hospice whistleblower case.