Harper’s Hospice Care: Referral Fees and Blank Prescription Forms

In the Harper’s Hospice Care settlement, the provider agreed to pay $150,000 over allegations that medical-directorship fees bought patient referrals and pre-signed blank prescription forms. The alleged exchange put a physician on both sides of the business: sending patients to the hospice and supplying signed forms for patients it treated. Buying referrals puts the physician’s paycheck ahead of the patient’s interests, while Medicare funds the care that follows.

Harper’s Hospice Care, Inc., a Mississippi provider, reached the settlement with the Department of Health and Human Services Office of Inspector General on April 25, 2014. The Inspector General’s announcement described alleged violations of the Civil Monetary Penalties Law involving physician self-referrals and kickbacks. This hospice fraud case centered on what the physician’s fee allegedly purchased.

Medical-Directorship Fees and Blank Prescription Forms

The Inspector General alleged that Harper’s paid a physician medical-directorship fees in exchange for referring patients for hospice services and pre-signing blank prescription forms. The forms were for patients treated by Harper’s Hospice.

That makes the paperwork as important as the payment. On the agency’s account, the physician’s signature was already on a prescription form while the form was still blank. The signature came before the instructions it would ordinarily approve. An insider who saw that process would know something a payment ledger could never show on its own.

The medical-director kickback allegation concerns the purpose of the compensation. Here, the Inspector General connected the money to patients sent to the business and signed forms supplied for its patients.

What Are the Responsibilities of a Hospice Medical Director?

A hospice medical director’s responsibilities include exercising clinical judgment about whether a patient qualifies for hospice and supporting that judgment with the patient’s medical circumstances. Under Medicare’s hospice coverage manual, eligibility depends on a prognosis of six months or less if the illness runs its normal course.

The physician’s role continues after admission, with recertification for later benefit periods. The written explanation must reflect the individual patient’s condition.

Why a Hospice Referral Has Continuing Value

Medicare’s daily hospice payment makes a referral valuable beyond the admission itself. A hospice receives payment for each enrolled day, including days when staff make no visit. The hospice also takes responsibility for the costs of care related to the terminal illness and related conditions.

The Inspector General’s January 2015 study, Medicare Hospices Have Financial Incentives to Provide Care in Assisted Living Facilities, found longer stays and higher payments for beneficiaries in assisted living than in other settings. The report made the financial incentive plain:

The finding helps explain why access to patients has commercial value in this industry: an enrollment can produce a continuing payment stream. Harper’s alleged purchase of referrals belongs in that business context.

Do Doctors Get Kickbacks for Referrals?

Yes. In hospice settlements, the government has alleged that physicians received kickbacks through medical-director stipends, signing bonuses and sham contracts.

The larger $1.4 million settlement involving Tapestry Hospice addressed the same alleged use of a medical-director position to buy referrals. The Justice Department alleged that monthly stipends and a signing bonus bought referrals. Compensation allegedly rose when a medical director referred more patients and fell when referrals stopped.

A former Tapestry employee brought the whistleblower case behind that settlement. That arrangement gives an insider a specific connection to recognize: a change in the flow of patients accompanied by a change in physician pay. The alleged incentive operated through compensation for a clinical role.

In a separate settlement involving Compassionate Care Hospice of Atlanta, the government alleged payments to a medical director for referrals and sham contracts with associate medical directors. The alleged payments were intended to induce referrals and certifications of hospice eligibility.

Harper’s adds its own concrete detail to that pattern: the physician allegedly supplied pre-signed blank prescription forms as part of the paid arrangement. The useful comparison is between the job the payment appeared to cover and what the government said the hospice bought.

What the Payment and Patient Records Can Show

For an insider who recognizes this arrangement, the important connection runs from the physician’s compensation to the referrals, the signed paperwork and the hospice’s billing. Our whistleblower experts examine those connections with you.

A medical-director agreement describes the work the hospice says it is buying. Payment records show the compensation. Referral records connect the physician to patients entering care. The prescription forms speak to a different question: what had been completed when the physician signed. Read together, those records can explain an exchange that looks ordinary when reduced to a payment under a professional title.

Different employees may know different parts. Finance staff may understand the payments, admissions staff the referral source, and clinical staff the paperwork used in patient care. An insider’s contribution is often knowing how those parts met in actual practice. We work with that knowledge to assess the arrangement and its connection to government payments.

For insiders seeing referral-payment practices in their own hospice, a whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. The connection between the arrangement, the patient and the paid claim is where our work with you begins.

You Know What the Physician Was Paid to Do

If you saw referral payments tied to a medical-director position or prescriptions signed in blank, speak to our whistleblower experts about how the arrangement worked. We develop your case around the money, the physician’s actual role and the patient records, and bring in healthcare fraud whistleblower lawyers who know hospice referral arrangements. We stay at your side as that inside knowledge becomes a case for recovery.