Articles Posted in HOSPICE MEDICARE FRAUD

The United States has filed suit against Creekside Hospice II LLC, Skilled Healthcare Group Inc. (SKG), its holding company, and Skilled Healthcare LLC (SKH), an administrative services subsidiary of SKG that operates Creekside (collectively the Creekside entities), alleging that these entities knowingly submitted ineligible claims for hospice services and inflated claims for patient visits to government health care programs, says the Justice Department

The Medicare and Medicaid hospice benefits are available for patients who elect palliative treatment (medical care focused on providing patients with relief from pain and stress) for a terminal illness and have a life expectancy of six months or less if their disease runs its normal course.  When Medicare or Medicaid patients receive hospice services, they no longer receive services designed to cure their illnesses.

The government’s complaint alleges that the Creekside entities knowingly submitted or caused the submission of false claims for hospice care for patients who were not terminally ill.  According to the complaint, the companies allegedly directed staff to enroll patients in the hospice program regardless of the patients’ eligibility for hospice benefits, sometimes by instructing staff to change records after the hospice submitted claims for payment to indicate that all requirements had been met.  Management from Creekside, SKG and SKH also allegedly instructed employees to alter medical records to make it appear that doctors at the hospice had conducted personal visits with the patients, when in fact they had not occurred, in order to ensure reimbursement from Medicare and Medicaid.  The complaint alleges that Creekside management aggressively discouraged staff from permitting patients or their families to revoke their elections to accept hospice benefits.  The complaint also alleges that staff at Creekside were discouraged from documenting known improvements in a patient’s health in the medical record, called “Chart Killers” by the hospice, to ensure that Medicare or Medicaid would pay the hospice’s claim.

The former Chief Operations Officer for  Horizons Hospice LLC, Mary Ann Stewart, has been indicted by a federal grand jury after she allegedly created a health fraud scheme in which people were put into a hospice center when they were not terminally ill and for making false declarations in front of a grand jury, according to the U.S. Attorney’s Office. Stewart, allegedly also provided untrue testimony to a series of four questions in front of a grand jury.

 Stewart was the chief operations officer for Horizons Hospice LLC, which provided end-of-life hospice care to eligible patients. A significant number of patients were eligible for Medicare and Medicaid. The indictment alleges Stewart orchestrated a scheme whereby she caused her staff to place non-qualifying patients into hospice care that were not appropriate, and then recertified the patients for continued hospice care.

A former medical director at the Horizons Hospice, Oliver Herndon, pleaded guilty to similar charges last fall according to Healthcare Finance News. The fraud allegedly resulted in the collections of millions of dollars in false billing as people who were not dying were sent to hospice care.

Uncle Sam  and  Nevada have joined in a whistleblower case alleging  a for-profit hospice  submitted millions of dollars in false claims to Medicare and Medicaid. Whistleblower Joanne Cretney-Tsosie, a clinical manager at Creekside Hospice II, filed a federal lawsuit under seal in 2012. Veneta Lepera, a former clinical manager for the company, filed a federal lawsuit under seal the following year.

The lawsuits were filed  under the federal and state False Claims Acts, which allow whistleblowers to inform the government of fraud and share in any recovered money. The lawsuits were combined and became public last week when the government filed its own complaint in the case.

Other defendants in the case are Skilled Healthcare Group Inc., Creekside’s holding company; and Skilled Healthcare LLC, which provides administrative services to Creekside.

The United States has  intervened against defendants in two whistleblower lawsuits  alleging Evercare Hospice and Palliative Care (Evercare) submitted false claims for the Medicare hospice benefit.  Evercare is now known as Optum Palliative and Hospice Care, which provides hospice services across the United States.  One of the suits names Evercare’s parent companies, including UnitedHealth Group Inc.

The lawsuits, filed by former employees of Evercare, allege that defendants violated the False Claims Act by knowingly submitting false claims for hospice benefits for patients who did not have a life expectancy of six months or less.  The complaints include allegations that management pressured employees and physicians to admit and retain patients who were not terminally ill and challenged or disregarded physicians’ decisions that patients should be discharged.

The Medicare hospice benefit is available for patients who elect palliative care (medical care focused on providing patients with relief from pain, symptoms or stress) for a terminal illness, and have a life expectancy of six months or less if their illness runs its normal course.  When a Medicare patient is admitted to hospice, that individual is no longer entitled to Medicare coverage for care designed to cure his or her illness.

The head of a large hospice care company has been charged with defrauding Medicare and Medicare by falsifying the level of hospice care provided for patients in nursing homes he controlled, say prosecutors. In the lawsuit against Seth Gillman, administrator and part owner of Passages Hospice LLC, the government charges that he trained nurses to look for signs that allegedly would qualify a hospice patient for general inpatient care, resulting in payments four times higher than routine care.

In many instances the suit says, patients were not terminally ill and stayed in hospice care longer than the required life expectancy of six months or less.

It is also alleged that network directors were paid bonuses based on the amount of general inpatient care they oversaw.

 

A for profit hospice and home health care company Beacon Hospice with eight locations in New Hampshire has agreed to pay $150 million to settle Government charges that it defrauded Medicare.

The whistleblower in the case, a former employee of Beacon Hospice in Concord, which was acquired by Amedisys in 2011 has filed a federal lawsuit saying the company wrongfully fired him. Laurie Turner of Concord, a business office specialist at Beacon claims she was fired for raising allegations that hospice staff were visiting patients without first getting orders from physicians and then improperly billing for those unauthorized visits.

This is not the only hospice company which has come under scrutiny by Uncle Sam recently for fraudulent practices. The U.S. Department of Justice filed suit in May against the nation’s largest for profit hospice chain VITAS Hospice Services. The DOJ says it submitted claims for people who were not terminally ill.

The United States Department of Justice has filed suit against Vitas Hospice Services LLC and Vitas Healthcare Corporation alleging they submitted false billings to Medicare for hospice services for ineligible patients. In addition, the government alleges the companies billed for services that were not actually provided and focused on maximizing reimbursement and disregarded the patient’s needs.  Some of the conduct cited by the government included: Falsifying medical records to support determinations of hospice eligibility and using aggressive marketing tactics and expecting employees to increase the number of crisis care claims submitted to Medicare, without regard to whether such care was medically appropriate.  Under the existing rules, to be eligible to participate in hospice care under Medicare, an individual must be certified as terminally ill, with medical prognosis that the patient’s life expectancy is six months or less if the illness runs its course. Jeffrey Newman represents whistleblowers.

Medicare’s bill for hospice care rose to more than $12 billion in 2009 and now an advisory committee for an independent Congressional oversight panel says that in  10 percent of the patients remained in hospice beyond seven months. Hospice is supposed to be end of life care in the home to help the dying and their family. When a patient enrolls in hospice, Medicare pays a flat rate of between $147 to $856 per day deoending on the level of care regardless of whether hospice actually provides services. When services are rendered, it is to provide dying patients with palliative care in their own homes or a nursing home. The Medicare reimbursement model gives incentive for hospice to seek out patients likely to live longer. In addition, upon review, it was found that hospices routinely fail to document what care patients receive. Whistleblower cases are popping up now revealing the fraud, under  laws allowing for a bounty for a significant bounty for the whistleblower. In 2007 the government obtained a $25 million award from SouthernCare one of the nation’s largest hospice companies.