Kaiser Permanente Health Insurance Plans - Hospice Fraud - A narrate For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms
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Hospice fraud in South Carolina and the United States is an addition 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 through the Medicare or Medicaid programs. The health care providers who provide 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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How is Hospice Fraud - A narrate For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms
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While most hospice health care organizations provide proper and ethical treatment for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may supervene in the payments of large sums of money from the federal government, there are great opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As modern federal hospice fraud promulgation 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 modern example of hospice fraud enthralling a South Carolina hospice is Southern Care, Inc., a hospice enterprise that in 2009 paid .7 million to determine an Fca case. The defendant operated hospices in 14 other states, too, along 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 concluding illnesses, and that the enterprise marketed to inherent 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 agreement 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, along 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 acquaint themselves with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and hospice fraud schemes that have developed across 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 executive sanctions, along with lengthy exclusions from working in an society which receives federal funds, great civil monetary penalties and fines, and criminal sanctions, along with incarceration. When a hospice employee discovers fraudulent guide enthralling Medicare or Medicaid billings or claims, the employee should not partake in such behavior, and it is imperative that the unlawful guide be reported to law promulgation and/or regulatory authorities. Not only does reporting such fraudulent Medicare or Medicaid practices shield the hospice employee from exposure to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may advantage financially under the bonus 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 profit 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 provide support services for the families of terminally ill patients. This care includes bodily care and counseling. Hospice care is normally provided by a public agency or hidden enterprise approved by Medicare and Medicaid. Hospice care is ready for all age groups, along with children, adults, and the elderly who are in the final stages of life. The purpose of hospice is to provide care for the terminally ill inpatient and his or her family and not to cure the concluding illness.
If a inpatient qualifies for hospice care, the inpatient can receive healing and support services, along with nursing care, healing public services, physician services, counseling, homemaker services, and other types of services. The hospice inpatient will have a team of doctors, nurses, home health aides, public workers, counselors and trained volunteers to help the inpatient and his or her family members cope with the symptoms and consequences of the concluding illness. While many hospice patients and their families can receive hospice care in the relax 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 aid is dependent on a whole of dissimilar factors, along with but not petite 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 median length of stay for hospice patients was about 21 days, the median length 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 hidden homes (40%). Other locations where hospice services are provided 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 concluding 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 hidden 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 provide 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 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 agency within the United States agency 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 aid operations, Medicaid and children's health, seek & certification and capability improvement. The Cms consortia consist of the following:
• Consortium for Medicare health Plans Operations
• Consortium for Financial administration and Fee for aid Operations
• Consortium for Medicaid and Children's health Operations
• Consortium for capability revising and seek & 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 enterprise line. Each Ca is responsible for consistent implementation of Cms programs, course and advice across all ten regions for matters pertaining to their enterprise line. In addition to accountability for a enterprise line, each Ca also serves as the Agency's senior administration legal for two or three Regional Offices (Ros), representing the Cms Administrator in external matters and overseeing executive operations.
Much of the daily administration and execution of the Medicare schedule is managed through hidden guarnatee associates that compact with the Government. These hidden guarnatee 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, along with Palmetto Government Benefits Administrators (hereinafter "Pgba"), a agency 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 careful representations of health care providers when processing claims.
Over the past forty years, the Medicare schedule has enabled the elderly and disabled to acquire significant healing services from healing providers throughout the United States. significant to the success of the Medicare schedule is the fundamental belief that health care providers accurately and in fact submit claims and bills to the Medicare Trust Fund only for those healing 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 healing providers not take advantage of their elderly and disabled patients.
The Medicaid schedule is ready only to inescapable low-income individuals and families who must meet eligibility requirements set forth by federal and state law. Each state sets its own guidelines concerning eligibility and services. Although administered by private 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 in fact submit claims and bills to schedule administrators only for those healing 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 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 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 identify 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 public protection 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. concluding illness is established when "the private has a healing diagnosis 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 healing 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 first 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 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 healing 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 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 inpatient must be maintained by the hospice, along with plan of care, assessments, clinical notes, signed observation of election, inpatient responses to medication and therapy, physician certifications and re-certifications, outcome data, expand directives and physician orders. 42 C.F.R. § 418.104.
The hospice must acquire a written observation of determination 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 healing treatment for the concluding 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 concluding illness and bereavement. 42 C.F.R. § 418.56. The Idg members must provide 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 provide 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 petite to, the following excellent and competent professionals: (i) A physician of treatment or osteopathy (who is an employee or under compact with the hospice); (ii) A registered nurse; (iii) A public 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 significant for the palliation and administration of the concluding illness as well as connected conditions. The private 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 private is terminally ill must be completed as set forth in section §418.22.
The public protection 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 significant for the palliation or administration of concluding illness...." 42 C.F.R. § 418.50 (hospice care must be "reasonable and significant for the palliation and administration of concluding 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 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: disposition home care (2.91); continuous home care (4.10); inpatient respite care (7.83); and, normal inpatient care (5.74).
The combination annual cap per inpatient in 2009 was ,014.50. This cap is thought about by adjusting the traditional hospice inpatient cap of ,500, set in 1984, by the consumer Price Index. See Cms Internet-Only manual 100-04, lesson 11, section 80.2; 42 U.S.C. § 1395f(i); 42 C.F.R. § 418.309. The Medicare Claims Processing Manual, at lesson 11 - Processing Hospice Claims, in Section 80.2, entitled "Cap on overall 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 petite 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 wish institutional health care providers, along 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 further guarantee that they understand that payment of a claim by Medicare and Medicaid is conditioned upon the claim and fundamental 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 through the Medicare contractor. I understand that payment of a claim by Medicare is conditioned upon the claim and the fundamental transaction complying with such laws, regulations, and schedule instructions (including, but not petite 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 lesson 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 manual Form Cms 1450 (sometime also called a Form Ub-04 or Form Ub-92), whether in paper or electronic form. These claim forms include representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of significant 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, strict 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 delight 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 annual cost and data narrative of Medicare payments received. 42 U.S.C. § 1395f(i)(3); 42 U.S.C. § 1395x(d)(d)(4). The annual hospice cost and data reports, Form Cms 1984-99, include representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of facts contained in the cost narrative may be punishable by criminal, civil and executive actions, along with fines and/or imprisonment; (2) if any services identified in the narrative were the stock of a direct or indirect kickback or were otherwise illegal, then criminal, civil and executive actions may result, along with fines and/or imprisonment; (3) the narrative is a true, strict and unblemished 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 concerning the provision of health care services and that the services identified in this cost narrative were provided in yielding with such laws and regulations.
Hospice Anti-Fraud promulgation Statutes
There are a whole of federal criminal, civil and executive promulgation provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, along with hospice fraud, and which help maintain schedule integrity and compliance. Some of the more important promulgation provisions of the Medicare statutes include 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 promulgation provisions which are used to combat Medicare and Medicaid fraud, along with hospice fraud, include 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 association 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 bonus 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 profit 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 narrative 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 narrative or statement material to an promulgation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an promulgation to pay or transmit money or property to the Government.... There is no requirement to prove exact intent to defraud. Rather, it is only significant 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 employee (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 action 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 payment for any extra damages sustained as a supervene of the discrimination or retaliation, along 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 agency where the frauds occurred, the relator's residence, and the defendant residence, will determine which agency 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 determine whether or not to intervene. During this time, federal government investigators located in South Carolina will investigate 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 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 customary 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 significant for the palliation of the symptoms of a terminally ill patient.
• A hospice paying amounts to the nursing home for "additional" services that Medicaid thought about 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 reconsider 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 facility benefit, with the prospect that after the inpatient exhausts the skilled nursing facility benefit, the inpatient will receive hospice services from that hospice.
• A hospice providing staff at its price to the nursing home to achieve duties that otherwise would be performed by the nursing home.
• Incomplete or no written Plan of Care was established or reviewed at exact intervals.
• Plan of Care did not include an estimation of needs.
• Fraudulent statements in a hospice's cost narrative to the government.
• observation of determination was not obtained or was fraudulently obtained.
• Rn supervisory visits were not made for home health aide services.
• Certification or Re-certification of concluding 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 guide a self-assessment of capability and care provided.
• Clinical records were not maintained for every patient.
• Interdisciplinary group did not report and modernize the plan of care for each patient.
Recent Hospice Fraud promulgation Cases
The Doj and U.S. Attorney's Offices have been active in enforcing hospice fraud cases.
In 2009, Kaiser Foundation Hospitals located an Fca lawsuit by paying .8 million to the federal government. The defendant allegedly failed to acquire written certifications of concluding illness for a whole of its patients.
In 2006, Odyssey Healthcare, a national hospice provider, paid .9 million to determine 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 agreement 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., located 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 located an Fca claim for 0,000 concerning allegations of fraudulently billing Medicare for ineligible hospice patients.
In 2000, Michigan osteopath Donald Dreyfuss, who pleaded guilty to criminal fraud charges, along with violation of the Aks for receiving illegal kickbacks from a hospice for recommending the hospice to the staff of his nursing home, located 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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