Milestone Hospice: The Patients Recruited and the Doctor Paid

Milestone Hospice fraud involved $1,941,254 in Medicare payments to Milestone and Sandanna Hospice from a physician’s unsuitable referrals, according to the Justice Department. The government also described how Milestone’s owner used patient recruiters to bring in people who did not qualify for hospice. The Grenada, Mississippi provider billed Medicare for ineligible patients or services never provided. The accounts connect the people bringing patients in with the business receiving the money.

Milestone’s Owner Used Patient Recruiters

Milestone’s owner operated the hospice and, the Justice Department said, used patient recruiters to solicit people who were not hospice appropriate. The Justice Department’s December 2015 account of the operation described fraudulent Medicare bills through Milestone for ineligible patients or services never provided.

An official quoted in the announcement said people being treated had no idea they were on hospice because they were not at the end of their lives. Medicare was paying for an end-of-life benefit that the patients did not even know they had entered. Taxpayers paid for the false claims, while patients lost an informed choice about their care.

That makes the conversation before admission part of the case. What a recruiter told a prospective patient, what the patient understood and what the hospice later billed belong in the same account. The admission paperwork recorded the result of decisions made before the patient reached the clinical staff.

Why a Hospice Admission Produces Revenue

Routine Medicare hospice payment follows the enrolled day, including days without a visit. The hospice receives the money and takes responsibility for care related to the terminal illness, including nursing, drugs, equipment and supplies. Recruitment therefore brings the provider a continuing payment stream.

The Inspector General’s explanation of the benefit sets out the admission requirements. Eligibility requires certification that the patient has a terminal illness with a life expectancy of six months or less if the illness runs its normal course. The patient must also elect hospice. That election changes Medicare coverage for treatment of the terminal illness: hospice provides comfort-focused care, and the patient gives up Medicare payment for related curative treatment.

For the person recruited without understanding the benefit, the consequences reach beyond a claim. The hospice has taken responsibility for related care, and the election has changed how Medicare covers treatment. The explanation given before enrollment is part of the health care decision.

That is why recruitment and referral payments matter inside a hospice business. They can influence who enters a benefit whose revenue continues after the recruiting work is over.

Do Doctors Get Kickbacks for Referrals?

Yes. In its August 2017 account of a Cleveland, Mississippi physician, the Justice Department said the doctor referred patients who were not hospice appropriate to Milestone and Sandanna.

The physician also received $47,750 by check from a hospice owner, in addition to cash payments, according to the Justice Department.

The physician account follows patients across provider names and follows payments back to their source. For someone who handles hospice referral payments, the connection between a patient list and a payment record can explain an arrangement that looks ordinary when each is seen alone.

What Evidence Is Needed to Prove Fraud?

Evidence in a hospice recruitment case connects the patient, the referral, the eligibility decision, the care supplied and the Medicare claim. Payment records can add who benefited from bringing the patient in. The useful account explains what the hospice told Medicare and who inside the business knew how that account was produced.

Admissions staff, nurses, billers and finance employees each see part of the same patient’s story.

We connect the clinical account with the referral payments and the Medicare bills. A clinical assessment can explain the patient’s condition. The instructions and payment records around it can explain why the business enrolled that patient anyway. That is where an insider’s knowledge gives the paperwork meaning.

What Patients Were Told Before They Signed

The whistleblower complaint involving AseraCare alleged that the company’s training encouraged enrollment while limiting the information patients received. Its description puts the patient conversation directly inside the business practice:

The parallel is the gap between obtaining an enrollment and giving the patient an informed choice. At Milestone, the government described patients who did not know they were on hospice. In the AseraCare complaint, the whistleblower alleged that training deliberately limited that choice. Admissions scripts and training instructions can show what employees were expected to say before a signed form entered the file.

The Mississippi Referral Account in the Inspector General’s National Review

The Inspector General used the Mississippi physician’s referral payments as an example in Hospice Deficiencies Pose Risks to Medicare Beneficiaries, published in July 2019. The Justice Department announcement it cites names Milestone and Sandanna as the hospices receiving the referrals.

Its broader account described hospice cases involving patients who were not terminally ill, altered patient records, falsified documentation and services never provided. That places the referral relationship alongside the clinical record and the bill. Each can help explain how a patient became a source of Medicare revenue.

A Hospice Whistleblower’s Share of the Recovery

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. A healthcare insider who understands the recruitment, clinical decisions or referral payments can explain how false claims reached Medicare. We bring the expertise to turn that knowledge into a hospice whistleblower case and stay beside you as it moves forward.

You Saw How the Patients Arrived

If you know who recruited the patients, what the physician received or how the hospice billed them, speak to one of our whistleblower experts about the operation you saw. We work beside you to build your strongest hospice whistleblower case and bring in hospice fraud whistleblower lawyers who understand bought referrals and unsupported admissions. We stay with you through the pursuit of the government’s recovery.