Six years after the initial complaint, a hospice provider was brought to justice after being found to have conspired to defraud Medicare of more than $9 million. In order to receive these fraudulent reimbursements, the hospice, Home Care Hospice, Inc. (HCH), accepted dozens of patients that did not qualify for Medicare benefits, falsifying documents as necessary. This hospice fraud led to Medicare being fraudulently billed an estimated $9,328,00 over the course of four years. Even more offensive, physicians also played a part in the scheme by forging certifications that non-terminal patients were, in fact, dying – and therefore eligible to receive hospice care.
In addition to receiving false certifications from physicians, it was discovered that the hospice provider itself had an internal system in order to further bilk Medicare for false claims. When the care facility was informed that they would be subjected to a Medicare claims audit, the director of HCH was provided with additional compensation on top of her hourly rate in order to draft over 150 fallacious patient care reports – such a large number of them, in fact, that thirty percent of the patients in the facility’s care should not have been in hospice at all.
This gross over-admittance was clearly illustrated when HCH, which has since been closed, was informed they had exceeded their Medicare reimbursement cap and would have to recompense over $2.6 million to the program. Upon hearing this, the director reviewed all patient files and discharged over 128 patients over the course of the next several months – many of whom were either ineligible for hospice care or had been in the facility’s care for over six months, which exceeds the limit of Medicare’s coverage for hospice services. Absurdly, after discharging these patients for not qualifying for hospice care, several were admitted to another hospice owned by the same owner.
This case was brought to the attention of the US Government by two previous employees, one of whom was terminated for bringing the alleged fraud to her superiors. Under the qui tam provision of the False Claims Act, both whistleblowers are entitled to a portion of the money recovered by the government as a reward for their uncovering of such an egregious fraudulent scheme.
Hospice fraud is particularly heinous because it deprives patients of curative treatment for their illnesses. By falsely certifying a patient for hospice, patients instead receive end-of-life care, which seeks to grant comfort and dignity in one’s dying days. Medicare only deems an individual eligible to receive hospice care if their life expectancy is less than six months; however, in 2014, more than ten percent of patients in US hospice facilities exceeded 180 days in care. Though there are other factors that may result in extended stays, hospice fraud plays an integral role in these overestimations of life expectancy – such as in the case of Evercare Hospice, who billed Medicare for patient stays up to three years in their facilities.
Whistleblower Justice Network Can Help You
Whistleblower Justice Network partners with whistleblowers to bring those who knowingly defraud the Medicare program to justice. Under the qui tam provisions of the False Claims Act, we assist individuals who bring forth information about fraudulent schemes in filing cases against those who seek to steal from the healthcare system for personal gain.
If you have meaningful information regarding hospice fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.