Blue Cross Blue Shield Maternity Coverage - Hospice Fraud - A characterize For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms
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Hospice Fraud - A characterize 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 approximately 40% to nearly 1.5 million, and of the 2.5 million population who died in 2008, nearly one million were hospice patients. The fantastic majority of population receiving hospice care receive federal benefits from the federal government straight through the Medicare or Medicaid programs. The health care providers who furnish 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 furnish approved and ethical treatment for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may succeed in the payments of large sums of money from the federal government, there are vast opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As recent federal hospice fraud enforcement actions have demonstrated, the whole of health care associates and individuals who are willing to try to defraud the Medicare and Medicaid hospice benefits programs is on the rise.
A recent example of hospice fraud piquant a South Carolina hospice is Southern Care, Inc., a hospice business that in 2009 paid .7 million to rule 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 final illnesses, and that the business marketed to potential 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 business transaction with the Oig as part of the settlement. The qui tam relators received approximately million.
Understanding the Consequences of Hospice Fraud and Whistleblower Actions
U.S. And South Carolina consumers, together with hospice patients and their family members, and health care employees who are employed in the hospice industry, as well as their Sc lawyers and attorneys, should tip off 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 field themselves to menagerial sanctions, together with lengthy exclusions from working in an organization which receives federal funds, vast civil monetary penalties and fines, and criminal sanctions, together with incarceration. When a hospice worker discovers fraudulent conduct piquant Medicare or Medicaid billings or claims, the worker should not participate in such behavior, and it is imperative that the unlawful conduct be reported to law enforcement and/or regulatory authorities. Not only does reporting such fraudulent Medicare or Medicaid practices shield the hospice worker from exposure to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may advantage financially under the recompense 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 aid for patients who are terminally ill. Hospices also furnish retain services for the families of terminally ill patients. This care includes physical care and counseling. Hospice care is normally provided by a group division or private business popular ,favorite 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 furnish care for the terminally ill sick person and his or her family and not to cure the final illness.
If a sick person qualifies for hospice care, the sick person can receive healing and retain services, together with nursing care, healing group services, physician services, counseling, homemaker services, and other types of services. The hospice sick person will have a team of doctors, nurses, home health aides, group workers, counselors and trained volunteers to help the sick person and his or her family members cope with the symptoms and consequences of the final illness. While many hospice patients and their families can receive hospice care in the comfort of their home, if the hospice patient's health deteriorates, the sick person can be transferred to a hospice facility, hospital, or nursing home to receive hospice care.
Hospice Care Statistics
The whole of days that a sick person receives hospice care is often referenced as the "length of stay" or "length of service." The distance of aid is dependent on a whole of different factors, together with but not minuscule to, the type and stage of the disease, the capability of and entrance to health care providers before the hospice referral, and the timing of the hospice referral. In 2008, the midpoint distance of stay for hospice patients was about 21 days, the midpoint distance of stay was about 69 days, approximately 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 private homes (40%). Other locations where hospice services are provided are nursing homes (22%), residential facilities (6%), hospice sick person facilities (21%), and acute care hospitals (10%). Hospice patients are ordinarily 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 final illness resulting in a hospice referral, cancer is the diagnosis for approximately 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 private guarnatee (8%), Medicaid (5%), charity care (1%) and self pay (1%).
As of 2008, there were approximately 4,700 locations which were providing hospice care in the United States, which represented about a 50% growth over ten years. There were about 3,700 associates 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 furnish health guarnatee 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 supervision (Hcfa), is the federal division within the United States division 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 structure based on the agency's key lines of business: Medicare health plans, Medicare financial management, Medicare fee for aid operations, Medicaid and children's health, discover & certification and capability improvement. The Cms consortia consist of the following:
• Consortium for Medicare health Plans Operations
• Consortium for Financial supervision and Fee for aid Operations
• Consortium for Medicaid and Children's health Operations
• Consortium for capability improvement and discover & 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 business line. Each Ca is responsible for consistent implementation of Cms programs, policy and advice over all ten regions for matters pertaining to their business line. In expanding to responsibility for a business line, each Ca also serves as the Agency's senior supervision lawful for two or three Regional Offices (Ros), representing the Cms Administrator in external matters and overseeing menagerial operations.
Much of the daily supervision and carrying out of the Medicare schedule is managed straight through private guarnatee associates that compact with the Government. These private guarnatee companies, sometimes called "Medicare Carriers" or "Fiscal Intermediaries," are expensed with and responsible for accepting Medicare claims, determining coverage, and manufacture payments from the Medicare Trust Fund. These carriers, together with Palmetto Government Benefits Administrators (hereinafter "Pgba"), a division of Blue Cross and Blue Shield of South Carolina, operate pursuant to 42 U.S.C. §§ 1395h and 1395u and rely on the good faith and specific representations of health care providers when processing claims.
Over the past forty years, the Medicare schedule has enabled the elderly and disabled to collect necessary healing services from healing providers throughout the United States. necessary to the success of the Medicare schedule is the basic concept that health care providers accurately and unmistakably submit claims and bills to the Medicare Trust Fund only for those healing treatments or services that are legitimate, inexpensive and medically necessary, in full yielding with all laws, regulations, rules, and conditions of participation, and, further, that healing providers not take advantage of their elderly and disabled patients.
The Medicaid schedule is ready only to safe bet low-income individuals and families who must meet eligibility requirements set forth by federal and state law. Each state sets its own guidelines regarding 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 unmistakably submit claims and bills to schedule administrators only for those healing treatments or services that are legitimate, inexpensive and medically necessary, in full yielding with all laws, regulations, rules, and conditions of participation, and, further, that healing providers not take advantage of their indigent patients.
Medicare & Medicaid Hospice Laws Which influence 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 sick person must be eligible for Medicare Part A and be terminally ill. 42 C.F.R. § 418.20. final illness is established when "the individual has a healing diagnosis that his or her life expectancy is 6 months or less if the illness runs its general course." 42 C.F.R. § 418.3; 42 U.S.C. § 1395x(d)(d)(3). The patient's physician and the healing director of the hospice must warrant in writing that the sick person is "terminally ill." 42 U.S.C. § 1395f(a)(7); 42 C.F.R. § 418.20. After a patient's preliminary certification, Medicare provides for two ninety-day advantage periods followed by an unlimited whole of sixty-day advantage periods. 42 U.S.C. § 1395d(a)(4). At the end of each ninety- or sixty-day period, the sick person can be re-certified only if at that time he or she has less than six months to live if the illness runs its general course. 42 U.S.C. § 1395f(a)(7)(A). The written certification and re-certifications must be maintained in the patient's healing records. 42 C.F.R. § 418.23. A written plan of care must be established for each sick person setting forth the types of hospice care services the sick person is scheduled to receive, 42 U.S.C. § 1395f(a)(7)(B), and the hospice care has to be provided 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 sick person must be maintained by the hospice, together with plan of care, assessments, clinical notes, signed observation of election, sick person responses to medication and therapy, physician certifications and re-certifications, outcome data, progress directives and physician orders. 42 C.F.R. § 418.104.
The hospice must collect a written observation of choosing from the sick person to elect to receive Medicare hospice benefits. 42 C.F.R. § 418.24. Importantly, once a sick person has elected to receive hospice care benefits, the sick person waives Medicare benefits for healing treatment for the final disease upon which is the admitting diagnosis. 42 C.F.R. § 418.24(d).
The hospice must prescription 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 final illness and bereavement. 42 C.F.R. § 418.56. The Idg members must furnish 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 furnish coordination of care and to ensure continuous evaluation of each patient's and family's needs and implementation of the interdisciplinary plan of care. The interdisciplinary group must include, but is not minuscule to, the following powerful and competent professionals: (i) A physician of treatment or osteopathy (who is an worker or under compact 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 inexpensive and necessary for the palliation and supervision of the final illness as well as associated 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 healing 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 provided 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 inexpensive and necessary for the palliation or supervision of final illness...." 42 C.F.R. § 418.50 (hospice care must be "reasonable and necessary for the palliation and supervision of final 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 sick person autonomy, entrance 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 advantage 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 family 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: routine home care (2.91); continuous home care (4.10); sick person respite care (7.83); and, general sick person care (5.74).
The composition each year cap per sick person in 2009 was ,014.50. This cap is determined by adjusting the primary hospice sick person cap of ,500, set in 1984, by the buyer Price Index. See Cms Internet-Only manual 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 comprehensive 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 sick person for these co-insurance payments. However, the co-insurance payments for drugs are minuscule to the lesser of or 5% of the cost of the drugs to the hospice, and the co-insurance payments for respite care are ordinarily 5% of the payment made by Medicare for such services. 42 C.F.R. § 418.400.
The Medicare and Medicaid programs need 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 warrant that they will comply with Medicare and Medicaid laws, regulations, and schedule instructions, and supplementary warrant 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 minuscule to, the Federal Aks and Stark laws), and on the provider's yielding with all applicable conditions of participation in Medicare."
Hospices are ordinarily 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 ordinarily file their hospice Medicare claims with their Fiscal Intermediary or Medicare Carrier pursuant to the Cms Claims manual Form Cms 1450 (sometime also called a Form Ub-04 or Form Ub-92), either in paper or electronic form. These claim forms consist of representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of necessary facts may serve as the basis for civil monetary penalties and criminal convictions; (2) submission of the claim constitutes certification that the billing facts is true, correct 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 sick person signatures are on file; and, (6) for Medicaid purposes, the submitter understands that because payment and delight of this claim will be from Federal and State funds, any false statements, documents, or concealment of a material fact are field to prosecution under applicable Federal or State Laws.
Hospices must also file with Cms an each year cost and data record 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, consist of representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of facts contained in the cost record may be punishable by criminal, civil and menagerial actions, together with fines and/or imprisonment; (2) if any services identified in the record were the product of a direct or indirect kickback or were otherwise illegal, then criminal, civil and menagerial actions may result, together with fines and/or imprisonment; (3) the record is a true, correct and complete statement prepared from the books and records of the provider in accordance with applicable instructions, except as noted; and, (4) the signing officer is customary with the laws and regulations regarding the provision of health care services and that the services identified in this cost record were provided in yielding with such laws and regulations.
Hospice Anti-Fraud enforcement Statutes
There are a whole of federal criminal, civil and menagerial enforcement provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, together with hospice fraud, and which help vocalize schedule integrity and compliance. Some of the more prominent enforcement provisions of the Medicare statutes consist of 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 enforcement provisions which are used to combat Medicare and Medicaid fraud, together with hospice fraud, consist of 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 advantage financially under the recompense 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 base 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 record 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 record or statement material to an enforcement to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an enforcement to pay or transmit money or property to the Government.... There is no requirement to prove specific intent to defraud. Rather, it is only necessary 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 worker (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 operation 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 succeed of the discrimination or retaliation, together with litigation costs and inexpensive 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 division where the frauds occurred, the relator's residence, and the defendant residence, will rule which division 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 rule either or not to intervene. While this time, federal government investigators settled in South Carolina will research 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 normally 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 general (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 customary with these hospice fraud practices. Tips on recognizing hospice frauds in South Carolina and the U.S. Are:
• A hospice gift 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 sick person 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 inexpensive or necessary for the palliation of the symptoms of a terminally ill patient.
• A hospice paying amounts to the nursing home for "additional" services that Medicaid determined 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 prospect that after the sick person exhausts the skilled nursing installation benefit, the sick person will receive hospice services from that hospice.
• A hospice providing staff at its price to the nursing home to perform duties that otherwise would be performed by the nursing home.
• Incomplete or no written Plan of Care was established or reviewed at specific intervals.
• Plan of Care did not consist of an evaluation of needs.
• Fraudulent statements in a hospice's cost record to the government.
• observation 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 final 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 recap and update the plan of care for each patient.
Recent Hospice Fraud enforcement 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 assertedly failed to collect written certifications of final illness for a whole of its patients.
In 2006, Odyssey Healthcare, a national hospice provider, paid .9 million to rule a qui tam suit for false claims under the Fca. The hospice fraud allegations were ordinarily 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 business transaction 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 ordinarily 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 regarding 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 customary 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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