HPH Hospice: The Patients Stayed, the Paperwork Changed

In the HPH Hospice settlement, the company agreed to pay $1 million over allegations of ineligible admissions, false records, inflated billing and free services exchanged for nursing-facility referrals. Two former employees described a business where staff allegedly had to admit patients despite eligibility objections, keep them enrolled even when stable, and create paperwork making patients appear to leave hospice and return.

Hernando-Pasco Hospice operated as HPH Hospice, a Florida nonprofit serving Hernando, Pasco and Citrus counties. The Justice Department announced the settlement on July 22, 2013. The former employees brought the qui tam case under the False Claims Act in federal court in Florida.

The government’s hospice fraud allegations covered January 1, 2005, through December 31, 2010. They connected management’s admission targets to delayed discharges, misleading medical records and false claims to Medicare and Medicaid.

Admissions Targets Overrode Eligibility Objections

HPH allegedly required staff to admit referrals even when employees questioned whether the patients qualified. Medicare’s hospice benefit serves patients with a life expectancy of six months or less if their illness runs its normal course. The government’s eligibility allegation was that management’s targets pushed staff to admit people who did not need end-of-life care.

The whistleblowers’ complaint described what happened when personnel objected:

The alleged instruction settled the admission decision before the patient’s eligibility did.

Keeping patients enrolled had its own alleged rule. According to the complaint, managers habitually instructed staff not to discharge patients during November through February, even when they were stable and did not qualify for hospice. They called it “cold and flu season.” In that account, the calendar overrode the patient’s condition.

The Paperwork Made Patients Leave and Return

The complaint alleged that HPH fabricated election and revocation documents to disguise continued care for ineligible patients. Those forms record a patient’s choice to enter hospice or leave the benefit. The alleged paperwork supplied choices the patients had not made.

The same paragraph described an alleged response to an audit. An HPH risk manager asked whether one whistleblower’s office had a blank consent form already signed by a particular patient. According to the complaint, the manager explained that the form would be fraudulently dated to replace one found missing during a chart audit.

The alleged response to the audit was to manufacture the appearance that the consent had been there all along.

Hospital transfers supplied another occasion for alleged backdating. The complaint said HPH personnel were told to date counterfeit revocation paperwork to the day a patient went to the hospital for palliative care, even when the patient had not signed a revocation then and learned only days later that the benefit had been revoked. The date on the form could tell a different story from the patient and the people caring for them.

Skilled-Nursing Claims and Free Referral Services

HPH’s alleged billing misconduct also reached the transition between skilled care and hospice. The complaint alleged that Medicare and Medicaid were billed under both benefits for care that should have been paid under one. It separately alleged that HPH backdated admission paperwork after patients left skilled care, generating hospice claims for care never provided.

A form created after skilled care ended allegedly reached backward to bill taxpayers for hospice care the patient never received. The people handling that transition could know when hospice care actually started and when its paperwork was prepared.

The government’s settlement announcement also alleged that HPH billed at higher reimbursement rates than it was entitled to receive. Medicare pays for different levels of hospice care.

The referral kickback allegation concerned what HPH gave the facilities sending patients. The Justice Department alleged that HPH provided free services to skilled nursing facilities in exchange for referrals.

Why an Enrolled Day Was Worth Keeping

Daily hospice payment makes admission and discharge decisions financial decisions too. Medicare pays for each enrolled day, whether or not hospice staff visit that day. The hospice takes responsibility for health care related to the terminal illness.

The Medicare Payment Advisory Commission explains in its March 2026 hospice report that services cluster at the beginning and end of a stay. Longer stays spread those more intensive periods across more days of payment. MedPAC also found higher Medicare margins among hospices with a larger share of patients in nursing facilities and assisted living facilities. That is the business setting in which a referral relationship becomes valuable.

The HHS Office of Inspector General’s January 2015 report, Medicare Hospices Have Financial Incentives to Provide Care in Assisted Living Facilities, examined Medicare hospice claims from 2007 through 2012. Hospices typically provided fewer than five hours of visits per week while receiving about $1,100 per week for each assisted-living beneficiary receiving routine home care. The payment also covered drugs, supplies and other hospice services.

The report put the incentive plainly:

The national findings explain why the HPH allegations belong together. Admissions targets bring patients in. Delayed discharges preserve enrolled days. False records can make those days look payable. The complaint described the paperwork that allegedly kept that sequence going inside HPH.

The Same Pressure Appeared in Other Hospice Cases

Other civil hospice cases connect admission pressure to the records supporting payment. In its settlement with Hospice Care of Kansas and Voyager HospiceCare, the government alleged that clinical employees received compensation tied to census and admissions, discharges were delayed, and staff were instructed to document patients’ conditions misleadingly.

In the Hospice of the Comforter settlement, DOJ alleged that staff were directed to admit all referrals regardless of eligibility, records were falsified, physicians’ roles in assessing terminal status were limited, and discharge was delayed.

These allegations put the pressure in the operating decisions employees see: whom to admit, what to write and when to let a patient leave. HPH’s complaint adds a particularly concrete account of fabricated patient choices and forms prepared to fill holes after the fact.

The Whistleblower Reward and Integrity Agreement

The Justice Department announced a collective whistleblower reward for the two former employees equivalent to 25% of the HPH settlement. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

HPH also entered a five-year Corporate Integrity Agreement with the HHS Office of Inspector General. The settlement announcement described procedures and reviews intended to prevent and promptly detect conduct like the alleged practices behind the case. The government had alleged that HPH failed to implement an adequate compliance program that might have corrected the admission and documentation problems.

What Evidence Is Needed to Prove Fraud?

In HPH’s case, the complaint connected patient care and billing to specific instructions and forms: a clinical objection answered by an admission order, a missing consent followed by a replacement request, and a hospital transfer followed by a backdated form.

A hospice fraud whistleblower may see only part of that sequence. Intake staff may know the instruction to admit. A clinician may know the patient’s condition. Billing or facility staff may know when skilled care ended, what hospice billed and what the referral facility received. We work with insiders to connect those different views to the claims and decisions they can explain.

You Saw the Decision Behind the Form

If admission orders, backdated forms or free facility services look familiar from your work in healthcare, speak with our whistleblower experts about what happened inside the hospice. We build your case around the clinical, billing and referral decisions you know, bring in hospice fraud whistleblower lawyers with the experience those facts demand, and stay beside you throughout the case.