On July 8, 2020, the United States Attorney for the Middle District of Florida announced that Florida hospice provider Hope Hospice has agreed to pay $3.2 million to resolve allegations that it knowingly submitted false claims to Medicare, Medicaid and TRICARE for hospice care provided to beneficiaries who did not qualify for government-funded hospice care. In order to be eligible for tax-payer funded hospice care, a Medicare beneficiary must be diagnosed as terminally ill–which means the beneficiary has a life expectancy of six months or less if their illness runs its normal course.
However, the United States alleged that Hope Hospice billed Medicare for patients that were not terminally ill. Some of Hope Hospice’s hospice patients received hospice care for over four years. Further, the settlement resolved allegations that Hope Hospice fraudulently billed Medicare, Medicaid and TRICARE for higher levels of hospice care than was medically necessary. These government health care programs reimburse for four different levels of hospice care: routine home care, continuous home care, inpatient respite care and general inpatient hospice care. Hope Hospice was alleged to have billed Medicare, Medicaid and TRICARE for medically unnecessary general inpatient (“GIP”) hospice care. GIP is reimbursed at a significantly higher rate by government health care programs but is only appropriate when a patient’s symptoms cannot be managed in other settings, such as the patient’s home. Further, GIP is intended to be utilized on a short-term basis and Hope Hospice allegedly billed Medicare for extended periods of GIP care–sometimes over two weeks.
This settlement resolves a lawsuit that was originally brought by a former Hope Hospice employee under the qui tam provisions of the False Claims Act. The qui tam provisions of the False Claims Act allow private individuals with knowledge of fraud against the government to file a lawsuit on behalf of the United States. If the lawsuit is successful in recovering funds stolen from taxpayers, the person who originally filed the lawsuit is entitled to a portion of the recovered funds. The individual who originally filed the case against Hope Hospice was a former Director of Hospice Care at Hope Hospice and will receive 19% of the government’s $3.2 million recovery, or $608,000. Frohsin Barger and Walthall would like to thank and congratulate the former Hope Hospice employee who brought this case and her attorney Mark Herbert Schlein of Baum, Hedlund, Aristei & Goldman, PC in Los Angeles, California as well as the government prosecutors and investigators with United States Department of Justice, the State of Florida Attorney General’s Office, Department of Health and Human Services, Defense Criminal Investigative Service, and the State of Florida Medicaid Fraud Control Unit Civil Enforcement Bureau for the successful resolution of this case and returning tax-payer funds back to government health care programs.
As evidenced by this settlement, common hospice fraud schemes often include:
Admitting and recertifying patients that are not terminally ill. Evidence of this type of hospice fraud is often patients that receive hospice care for extended time periods, such as several years or hospice companies that frequently change patient’s admitting diagnosis to attempt to justify their false certifications of terminal illness.
Billing for higher levels of hospice care than is medically necessary. Evidence of this type of hospice fraud is often corporate pressure to utilize the higher levels of hospice care–even when patients symptoms are well-managed through routine home hospice care.
However, other types of hospice fraud that is actionable under the False Claims Act can be if hospice companies provide payments to referral sources for hospice referrals or utilize patient recruiters to aggressively solicit hospice patients.
For additional information on hospice fraud, access the following report by the Department of Health and Human Services Office of Inspector General titled: Vulnerabilities in the Medicare Hospice Program Affect Quality Care and Program Integrity
For the full Department of Justice Press Release on the Hope Hospice Settlement, click here
For more information on Hospice Fraud or the False Claims Act, contact Frohsin Barger & Walthall