The Huntsville Times reports that national Medicare Hospice provider SouthernCare agreed to pay $24.7 million to settle allegations that it fraudulently admitted nonqualifying patients to its Hospice program and submitted false claims for payment to Medicare.  The Times quoted whistleblower attorney Henry Frohsin as saying, “This was a case of corporate excess and greed over many years that was driven not by care for the patient, but driven by number and payments from the taxpayers.”

According to the Complaint filed by Frohsin & Barger on behalf of a nurse and former employee of SouthernCare,  the company submitted Medicare billing for and provided in-home hospice services for patients who continued to live for years.  The Huntsville Times reports:

‘Many of them were not in the last stages of their lives,’ said Frohsin, calling it the largest hospice fraud case in U.S. history.
Founded in 1995, SouthernCare maintains its headquarters in Birmingham and operates 95 sites in 15 states. The company is most active in Alabama where it provides care from 27 offices, including one in Huntsville on South Memorial Parkway.

The local office referred all questions to a corporate spokesperson, who supplied a written response late Thursday.

‘Importantly, the dispute was wholly unrelated to the quality of hospice care provided by SouthernCare,’ reads the company statement, ‘but rather, dealt with the criteria for determining when a patient is eligible to receive hospice services under Medicare rules.’

To qualify for Medicare benefits for hospice care, patients must be diagnosed with a life expectancy of six months or less. Federal investigators argued that SouthernCare submitted claims for patients who were not terminally ill and did not require in-home hospice care, which can include everything from sponge baths to spiritual counseling to pain pills.

But according to SouthernCare, it’s not always easy to tell who qualifies. The company argues in its statement that ‘accurately predicting life expectancy is an inexact science.’

According to the Department of Justice, the hefty payout resulted from claims filed by two former caseworkers in Birmingham. Their lawsuits were kept sealed as the federal government investigated the charges.

‘Our investigation showed a pattern and practice to falsely admit patients to hospice care who did not qualify and to bill Medicare for that care,’ said Alice H. Martin, U.S. Attorney for the Northern District of Alabama. ‘This resulted in taxpayers bearing inappropriate costs.’

To report Medicare Hospice fraud, contact Frohsin & Barger.