Century 21 New Braunfels Tx - Hospice Fraud - A relate For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms
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Hospice Fraud - A relate For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms
Hospice fraud in South Carolina and the United States is an expanding question as the whole of hospice patients has exploded over the past few years. From 2004 to 2008, the whole of patients receiving hospice care in the United States grew roughly 40% to nearly 1.5 million, and of the 2.5 million people who died in 2008, nearly one million were hospice patients. The fabulous majority of people receiving hospice care receive federal benefits from the federal government straight through the Medicare or Medicaid programs. The health care providers who contribute hospice services traditionally enroll in the Medicare and Medicaid programs in order to qualify to receive payments under these government programs for services rendered to Medicare and Medicaid eligible patients.
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While most hospice health care organizations contribute approved and ethical rehabilitation for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may effect in the payments of large sums of money from the federal government, there are tremendous opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As up-to-date federal hospice fraud compulsion actions have demonstrated, the whole of health care fellowships and individuals who are willing to try to defraud the Medicare and Medicaid hospice benefits programs is on the rise.
A up-to-date example of hospice fraud curious a South Carolina hospice is Southern Care, Inc., a hospice company that in 2009 paid .7 million to resolve an Fca case. The defendant operated hospices in 14 other states, too, together with Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, to wit, were not terminally ill, lack of documentation of terminal illnesses, and that the company marketed to possible patients with the promise of free medications, supplies, and the provision of home health aides. Southern Care also entered into a 5-year Corporate Integrity trade with the Oig as part of the settlement. The qui tam relators received roughly million.
Understanding the Consequences of Hospice Fraud and Whistleblower Actions
U.S. And South Carolina consumers, together with hospice patients and their house members, and health care employees who are employed in the hospice industry, as well as their Sc lawyers and attorneys, should clue themselves with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and hospice fraud schemes that have developed over the country. Consumers need to safe themselves from unethical hospice providers, and hospice employees need to guard against knowingly or unwittingly participating in health care fraud against the federal government because they may subject themselves to administrative sanctions, together with lengthy exclusions from working in an society which receives federal funds, tremendous civil monetary penalties and fines, and criminal sanctions, together with incarceration. When a hospice laborer discovers fraudulent conduct curious Medicare or Medicaid billings or claims, the laborer should not partake in such behavior, and it is imperative that the unlawful conduct be reported to law compulsion and/or regulatory authorities. Not only does reporting such fraudulent Medicare or Medicaid practices shield the hospice laborer from exposure to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may benefit financially under the reward provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States.
Types of Hospice Care Services
Hospice care is a type of health care assistance for patients who are terminally ill. Hospices also contribute withhold services for the families of terminally ill patients. This care includes physical care and counseling. Hospice care is commonly in case,granted by a group branch or incommunicable company stylish by Medicare and Medicaid. Hospice care is ready for all age groups, together with children, adults, and the elderly who are in the final stages of life. The purpose of hospice is to contribute care for the terminally ill inpatient and his or her house and not to cure the terminal illness.
If a inpatient qualifies for hospice care, the inpatient can receive medical and withhold services, together with nursing care, medical group services, physician services, counseling, homemaker services, and other types of services. The hospice inpatient will have a team of doctors, nurses, home health aides, group workers, counselors and trained volunteers to help the inpatient and his or her house members cope with the symptoms and consequences of the terminal illness. While many hospice patients and their families can receive hospice care in the relieve of their home, if the hospice patient's health deteriorates, the inpatient can be transferred to a hospice facility, hospital, or nursing home to receive hospice care.
Hospice Care Statistics
The whole of days that a inpatient receives hospice care is often referenced as the "length of stay" or "length of service." The length of assistance is dependent on a whole of distinct factors, together with but not miniature to, the type and stage of the disease, the capability of and passage to health care providers before the hospice referral, and the timing of the hospice referral. In 2008, the mean length of stay for hospice patients was about 21 days, the mean length of stay was about 69 days, roughly 35% of hospice patients died or were discharged within 7 days of the hospice referral, and only about 12% of hospice patients survived longer than 180 days.
Most hospice care patients receive hospice care in incommunicable homes (40%). Other locations where hospice services are in case,granted are nursing homes (22%), residential facilities (6%), hospice inpatient facilities (21%), and acute care hospitals (10%). Hospice patients are generally the elderly, and hospice age group percentages are 34 years or less (1%), 35 - 64 years (16%), 65 - 74 years (16%), 75 - 84 years (29%), and over 85 years (38%). As for the terminal illness resulting in a hospice referral, cancer is the prognosis for roughly 40% of hospice patients, followed by debility unspecified (15%), heart disease (12%), dementia (11%), lung disease (8%), stroke (4%) and kidney disease (3%). Medicare pays the great majority of hospice care expenses (84%), followed by incommunicable assurance (8%), Medicaid (5%), charity care (1%) and self pay (1%).
As of 2008, there were roughly 4,700 locations which were providing hospice care in the United States, which represented about a 50% increase over ten years. There were about 3,700 fellowships and organizations which were providing hospice services in the United States. About half of the hospice care providers in the United States are for-profit organizations, and about half are non-profit organizations.
General overview of the Medicare and Medicaid Programs
In 1965, Congress established the Medicare schedule to contribute health assurance for the elderly and disabled. Payments from the Medicare schedule arise from the Medicare Trust fund, which is funded by government contributions and straight through payroll deductions from American workers. The Centers for Medicare and Medicaid Services (Cms), previously known as the health Care Financing administration (Hcfa), is the federal branch within the United States branch of health and Human Services (Hhs) that administers the Medicare schedule and works in partnership with state governments to administer Medicaid.
In 2007, Cms reorganized its ten geography-based field offices to a Consortia buildings based on the agency's key lines of business: Medicare health plans, Medicare financial management, Medicare fee for assistance operations, Medicaid and children's health, contemplate & certification and capability improvement. The Cms consortia consist of the following:
• Consortium for Medicare health Plans Operations
• Consortium for Financial administration and Fee for assistance Operations
• Consortium for Medicaid and Children's health Operations
• Consortium for capability improvement and contemplate & Certification Operations
Each consortium is led by a Consortium Administrator (Ca) who serves as the Cms's national focal point in the field for their company line. Each Ca is responsible for consistent implementation of Cms programs, procedure and guidance over all ten regions for matters pertaining to their company line. In expanding to responsibility for a company line, each Ca also serves as the Agency's senior administration valid for two or three Regional Offices (Ros), representing the Cms Administrator in external matters and overseeing administrative operations.
Much of the daily administration and performance of the Medicare schedule is managed straight through incommunicable assurance fellowships that contract with the Government. These incommunicable assurance companies, sometimes called "Medicare Carriers" or "Fiscal Intermediaries," are expensed with and responsible for accepting Medicare claims, determining coverage, and development payments from the Medicare Trust Fund. These carriers, together with Palmetto Government Benefits Administrators (hereinafter "Pgba"), a branch of Blue Cross and Blue Shield of South Carolina, control pursuant to 42 U.S.C. §§ 1395h and 1395u and rely on the good faith and right representations of health care providers when processing claims.
Over the past forty years, the Medicare schedule has enabled the elderly and disabled to procure requisite medical services from medical providers throughout the United States. requisite to the success of the Medicare schedule is the basic view that health care providers accurately and easily submit claims and bills to the Medicare Trust Fund only for those medical treatments or services that are legitimate, uncostly and medically necessary, in full yielding with all laws, regulations, rules, and conditions of participation, and, further, that medical providers not take benefit of their elderly and disabled patients.
The Medicaid schedule is ready only to confident low-income individuals and families who must meet eligibility requirements set forth by federal and state law. Each state sets its own guidelines with regard to eligibility and services. Although administered by individual states, the Medicaid schedule is funded primarily by the federal government. Medicaid does not pay money to patients; rather, it sends payments directly to the patient's health care providers. Like Medicare, the Medicaid schedule depends on health care providers to accurately and easily submit claims and bills to schedule administrators only for those medical treatments or services that are legitimate, uncostly and medically necessary, in full yielding with all laws, regulations, rules, and conditions of participation, and, further, that medical providers not take benefit of their indigent patients.
Medicare & Medicaid Hospice Laws Which work on Sc Hospices
Hospice fraud occurs when hospice organizations, by and straight through their employees, agents and owners, knowingly violate the terms and conditions of the applicable Medicare and Medicaid hospice statutes, regulations, rules and conditions of participation. In order to be able to recognize hospice fraud, hospices, hospice patients, hospice employees and their attorneys and lawyers must know the Medicare laws and requirements relating to hospice care benefits.
Medicare's two main sources of authorization for hospice benefits are found in the group security Act and the U.S. Code of Federal Regulations. The statutory provisions are primarily found at 42 U.S.C. §§ 1395d, 1395e, 1395f(a)(7), 1395x(d)(d), and 1395y, and the regulatory provisions are found at 42 C.F.R. Part 418.
To be eligible for Medicare benefits for hospice care, the inpatient must be eligible for Medicare Part A and be terminally ill. 42 C.F.R. § 418.20. terminal illness is established when "the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course." 42 C.F.R. § 418.3; 42 U.S.C. § 1395x(d)(d)(3). The patient's physician and the medical director of the hospice must guarantee in writing that the inpatient is "terminally ill." 42 U.S.C. § 1395f(a)(7); 42 C.F.R. § 418.20. After a patient's initial certification, Medicare provides for two ninety-day benefit periods followed by an unlimited whole of sixty-day benefit periods. 42 U.S.C. § 1395d(a)(4). At the end of each ninety- or sixty-day period, the inpatient can be re-certified only if at that time he or she has less than six months to live if the illness runs its normal course. 42 U.S.C. § 1395f(a)(7)(A). The written certification and re-certifications must be maintained in the patient's medical records. 42 C.F.R. § 418.23. A written plan of care must be established for each inpatient setting forth the types of hospice care services the inpatient is scheduled to receive, 42 U.S.C. § 1395f(a)(7)(B), and the hospice care has to be in case,granted in accordance with such plan of care. 42 U.S.C. § 1395f(a)(7)(C); 42 C.F.R. § 418.56. Clinical records for each hospice inpatient must be maintained by the hospice, together with plan of care, assessments, clinical notes, signed consideration of election, inpatient responses to medication and therapy, physician certifications and re-certifications, outcome data, advance directives and physician orders. 42 C.F.R. § 418.104.
The hospice must procure a written consideration of choosing from the inpatient to elect to receive Medicare hospice benefits. 42 C.F.R. § 418.24. Importantly, once a inpatient has elected to receive hospice care benefits, the inpatient waives Medicare benefits for medical rehabilitation for the terminal disease upon which is the admitting diagnosis. 42 C.F.R. § 418.24(d).
The hospice must designate an Interdisciplinary Group (Idg) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. 42 C.F.R. § 418.56. The Idg members must contribute the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. A registered nurse that is a member of the Idg must be designated to contribute coordination of care and to ensure continuous estimation of each patient's and family's needs and implementation of the interdisciplinary plan of care. The interdisciplinary group must include, but is not miniature to, the following remarkable and competent professionals: (i) A physician of rehabilitation or osteopathy (who is an laborer or under contract with the hospice); (ii) A registered nurse; (iii) A group worker; and, (iv) A pastoral or other counselor. 42 C.F.R. § 418.56.
The Medicare hospice regulations, at 42 C.F.R. § 418.200, summarize the requirements for hospice coverage in pertinent part as follows:
To be covered, hospice services must meet the following requirements. They must be uncostly and requisite for the palliation and administration of the terminal illness as well as related conditions. The individual must elect hospice care in accordance with §418.24. A plan of care must be established and periodically reviewed by the attending physician, the medical director, and the interdisciplinary group of the hospice schedule as set forth in §418.56. That plan of care must be established before hospice care is provided. The services in case,granted must be consistent with the plan of care. A certification that the individual is terminally ill must be completed as set forth in section §418.22.
The group security Act, at 42 U.S.C. § 1395y(a), limits Medicare hospice benefits, providing in pertinent part as follows: "Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services-... (C) in the case of hospice care, which are not uncostly and requisite for the palliation or administration of terminal illness...." 42 C.F.R. § 418.50 (hospice care must be "reasonable and requisite for the palliation and administration of terminal illness"). Palliative care is defined in the regulations as "patient and family-centered care that optimizes capability of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate inpatient autonomy, passage to information, and choice." 42 C.F.R. § 418.3.
Medicare pays hospice agencies a daily rate for each day a beneficiary is enrolled in the hospice benefit and receives hospice care. The daily payments are made regardless of the whole of services furnished on a given day and are intended to cover costs that the hospice incurs in furnishing services identified in the patient's plan of care. There are four levels of payments which are made based on the whole of care required to meet beneficiary and house needs. 42 C.F.R. § 418.302; Cms Hospice Fact Sheet, November 2009. These four levels, and the corresponding 2010 daily rates, are as follows: disposition home care (2.91); continuous home care (4.10); inpatient respite care (7.83); and, normal inpatient care (5.74).
The composition each year cap per inpatient in 2009 was ,014.50. This cap is carefully by adjusting the customary hospice inpatient cap of ,500, set in 1984, by the consumer Price Index. See Cms Internet-Only hand-operated 100-04, part 11, section 80.2; 42 U.S.C. § 1395f(i); 42 C.F.R. § 418.309. The Medicare Claims Processing Manual, at part 11 - Processing Hospice Claims, in Section 80.2, entitled "Cap on ample Hospice Reimbursement," provides in pertinent part as follows: "Any payments in excess of the cap must be refunded by the hospice."
Hospice patients are responsible for Medicare co-insurance payments for drugs and respite care, and the hospice may payment the inpatient for these co-insurance payments. However, the co-insurance payments for drugs are miniature to the lesser of or 5% of the cost of the drugs to the hospice, and the co-insurance payments for respite care are generally 5% of the payment made by Medicare for such services. 42 C.F.R. § 418.400.
The Medicare and Medicaid programs require institutional health care providers, together with hospice organizations, to file an enrollment application in order to qualify to receive the programs' benefits. As part of these enrollment applications, the hospice providers guarantee that they will comply with Medicare and Medicaid laws, regulations, and schedule instructions, and added guarantee that they understand that payment of a claim by Medicare and Medicaid is conditioned upon the claim and basic transaction complying with such schedule laws and requirements. The Medicare Enrollment Application which hospice providers must execute, Form Cms-855A, states in part as follows: "I agree to abide by the Medicare laws, regulations and schedule instructions that apply to this provider. The Medicare laws, regulations, and schedule instructions are ready straight through the Medicare contractor. I understand that payment of a claim by Medicare is conditioned upon the claim and the basic transaction complying with such laws, regulations, and schedule instructions (including, but not miniature to, the Federal Aks and Stark laws), and on the provider's yielding with all applicable conditions of participation in Medicare."
Hospices are generally required to bill Medicare on a monthly basis. See the Medicare Claims Processing Manual, at part 11 - Processing Hospice Claims, in Section 90 - Frequency of Billing. Hospices generally file their hospice Medicare claims with their Fiscal Intermediary or Medicare Carrier pursuant to the Cms Claims hand-operated Form Cms 1450 (sometime also called a Form Ub-04 or Form Ub-92), either in paper or electronic form. These claim forms comprise representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of requisite data may serve as the basis for civil monetary penalties and criminal convictions; (2) submission of the claim constitutes certification that the billing data is true, accurate and complete; (3) the submitter did not knowingly or recklessly disregard or misrepresent or conceal material facts; (4) all required physician certifications and re-certifications are on file; (5) all required inpatient signatures are on file; and, (6) for Medicaid purposes, the submitter understands that because payment and pleasure of this claim will be from Federal and State funds, any false statements, documents, or concealment of a material fact are subject to prosecution under applicable Federal or State Laws.
Hospices must also file with Cms an each year cost and data description of Medicare payments received. 42 U.S.C. § 1395f(i)(3); 42 U.S.C. § 1395x(d)(d)(4). The each year hospice cost and data reports, Form Cms 1984-99, comprise representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of data contained in the cost description may be punishable by criminal, civil and administrative actions, together with fines and/or imprisonment; (2) if any services identified in the description were the stock of a direct or indirect kickback or were otherwise illegal, then criminal, civil and administrative actions may result, together with fines and/or imprisonment; (3) the description is a true, accurate and faultless statement ready from the books and records of the victualer in accordance with applicable instructions, except as noted; and, (4) the signing officer is familiar with the laws and regulations with regard to the provision of health care services and that the services identified in this cost description were in case,granted in yielding with such laws and regulations.
Hospice Anti-Fraud compulsion Statutes
There are a whole of federal criminal, civil and administrative compulsion provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, together with hospice fraud, and which help assert schedule integrity and compliance. Some of the more prominent compulsion provisions of the Medicare statutes comprise the following: 42 U.S.C. § 1320a-7b (Criminal fraud and anti-kickback penalties); 42 U.S.C. § 1320a-7a and 42 U.S.C. § 1320a-8 (Civil monetary penalties for fraud); 42 U.S.C. § 1320a-7 (Administrative exclusions from participation in Medicare/Medicaid programs for fraud); 42 U.S.C. § 1320a-4 (Administrative subpoena power for the Comptroller General).
Other criminal compulsion provisions which are used to combat Medicare and Medicaid fraud, together with hospice fraud, comprise the following: 18 U.S.C. § 1347 (General health care fraud criminal statute); 21 U.S.C. §§ 353, 333 (Prescription Drug Marketing Act); 18 U.S.C. § 669 (Theft or Embezzlement in relationship with health Care); 18 U.S.C. § 1035 (False statements relating to health Care); 18 U.S.C. § 2 (Aiding and Abetting); 18 U.S.C. § 3 (Accessory after the Fact); 18 U.S.C. § 4 (Misprision of a Felony); 18 U.S.C. § 286 (Conspiracy to defraud the Government with respect to Claims); 18 U.S.C. § 287 (False, Fictitious or Fraudulent Claims); 18 U.S.C. § 371 (Criminal Conspiracy); 18 U.S.C. § 1001 (False Statements); 18 U.S.C. § 1341 (Mail Fraud); 18 U.S.C. § 1343 (Wire Fraud); 18 U.S.C. § 1956 (Money Laundering); 18 U.S.C. § 1957 (Money Laundering); and, 18 U.S.C. § 1964 (Racketeer Influenced and Corrupt Organizations ("Rico")).
The False Claims Act (Fca)
Hospice fraud whistleblowers may benefit financially under the reward provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States. The plaintiff in a hospice fraud whistleblower suit is also known as a relator. The most tasteless Fca provisions upon which hospice fraud qui tam or whistleblower relators rely are found in 31 U.S.C. § 3729: (A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval; (B) knowingly makes, uses, or causes to be made or used, a false description or statement material to a false or fraudulent claim; (C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);..., and, (G) knowingly makes, uses, or causes to be made or used, a false description or statement material to an compulsion to pay or forward money or asset to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an compulsion to pay or forward money or asset to the Government.... There is no requirement to prove definite intent to defraud. Rather, it is only requisite to prove actual knowledge of the false claims, false statements, or false records, or the defendant's deliberate indifference or reckless disregard of the truth or falsity of the information. 31 U.S.C. § 3729(b).
The Fca anti-retaliation provision protects the hospice whistleblower from retaliation from the hospice when the laborer (or a contractor) "is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment" for taking performance to try to stop the fraudulent activity. 31 U.S.C. § 3730(h). A hospice employee's relief includes reinstatement, 2 times the whole of back pay, interest on the back pay, and recompense for any extra damages sustained as a effect of the discrimination or retaliation, together with litigation costs and uncostly attorneys' fees.
A Sc hospice fraud Fca whistleblower would initially file a disclosure statement, complaint and supporting documents with the U.S. Attorney's Office in Columbia, South Carolina, and the Us Attorney General. After the disclosures are filed, a federal court complaint can be filed. The Sc branch where the frauds occurred, the relator's residence, and the defendant residence, will resolve which branch the case will be assigned. There are eleven federal court divisions in South Carolina. Once the case has been filed, the government has 60 days to resolve either or not to intervene. During this time, federal government investigators settled in South Carolina will explore the claims. If the case complex Medicaid, Sc Medicaid fraud unit investigators will likely become complex as well. If the government intervenes in the case, the U.S. Attorney for South Carolina is commonly the lead attorney. If the government does not intervene, the relator's Sc attorney will prosecute the case. In South Carolina, expect a qui tam case to take one to two years to get to trial.
Tips on Recognizing Hospice Fraud Schemes
The Hhs Office of Inspector normal (Oig) has issued extra Fraud Alerts for fraudulent and abusive practices of hospices. U.S. And South Carolina hospices, patients, hospice employees and whistleblowers, their attorneys and lawyers, should be familiar with these hospice fraud practices. Tips on recognizing hospice frauds in South Carolina and the U.S. Are:
• A hospice offering free goods or goods at below store value to induce a nursing home to refer patients to the hospice.
• False representations in a hospice's Medicare/Medicaid enrollment form.
• A hospice paying "room and board" payments to the nursing home in amounts in excess of what the nursing home would have received directly from Medicaid had the inpatient not been enrolled in the hospice.
• False statements in a hospice's claim form (Cms Forms 1450, Ub-04 or Ub-92).
• A hospice falsely billing for services that were not uncostly or requisite for the palliation of the symptoms of a terminally ill patient.
• A hospice paying amounts to the nursing home for "additional" services that Medicaid carefully included in its room and board payment to the hospice.
• A hospice paying above fair store value for "additional" non-core services which Medicaid does not think to be included in its room and board payments to the nursing home.
• A hospice referring patients to a nursing home to induce the nursing home to refer its patients to the hospice.
•A hospice providing free (or below fair store value) care to nursing home patients, for whom the nursing home is receiving Medicare payment under the skilled nursing installation benefit, with the expectation that after the inpatient exhausts the skilled nursing installation benefit, the inpatient will receive hospice services from that hospice.
• A hospice providing staff at its expense to the nursing home to accomplish duties that otherwise would be performed by the nursing home.
• Incomplete or no written Plan of Care was established or reviewed at definite intervals.
• Plan of Care did not comprise an estimation of needs.
• Fraudulent statements in a hospice's cost description to the government.
• consideration of choosing was not obtained or was fraudulently obtained.
• Rn supervisory visits were not made for home health aide services.
• Certification or Re-certification of terminal illness was not obtained or was fraudulently obtained.
• No Plan of care was included for bereavement services.
• Fraudulent billing for upcoded levels of hospice care.
• Hospice did not conduct a self-assessment of capability and care provided.
• Clinical records were not maintained for every patient.
• Interdisciplinary group did not narrate and modernize the plan of care for each patient.
Recent Hospice Fraud compulsion Cases
The Doj and U.S. Attorney's Offices have been active in enforcing hospice fraud cases.
In 2009, Kaiser Foundation Hospitals settled an Fca lawsuit by paying .8 million to the federal government. The defendant allegedly failed to procure written certifications of terminal illness for a whole of its patients.
In 2006, Odyssey Healthcare, a national hospice provider, paid .9 million to resolve a qui tam suit for false claims under the Fca. The hospice fraud allegations were generally that Odyssey billed Medicare for providing hospice care to patients when they were not terminally ill and ineligible for Medicare hospice benefits. A Corporate Integrity trade was also a part of the settlement. The hospice fraud qui tam relator received .3 million for blowing the whistle on the defendant.
In 2005, Faith Hospice, Inc., settled claims an Fca claim for 0,000. The hospice fraud allegations were generally that Faith Hospice billed Medicare for providing hospice care to patients more than half of whom were not terminally ill.
In 2005, Home Hospice of North Texas settled an Fca claim for 0,000 with regard to allegations of fraudulently billing Medicare for ineligible hospice patients.
In 2000, Michigan osteopath Donald Dreyfuss, who pleaded guilty to criminal fraud charges, together with violation of the Aks for receiving illegal kickbacks from a hospice for recommending the hospice to the staff of his nursing home, settled an Fca suit for million.
Conclusion
Hospice fraud is a growing question in South Carolina and throughout the United States. South Carolina hospice patients, hospice employees, and their Sc lawyers and attorneys, should be familiar with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and typical hospice fraud schemes. Hospice organizations should take steps to ensure full yielding with Medicare/Medicaid hospice billing requirements to avoid hospice fraud allegations and Fca litigation.
© 2010 Joseph P. Griffith, Jr.
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