Articles Tagged with hospice fraud

Chemed has paid the U.S. government $75 million to settle lawsuits claiming the hospice care provider submitted false claims to Medicare. The settlement relates to allegations for the period 2002 and 2013 Chemed subsidiary Vitas knowingly submitted or caused to be submitted false claims to Medicare for services to hospice patients who were not terminally ill. As part of the settlement, Vitas also entered into a five-year corporate integrity agreement with the HHS Office of Inspector General to settle the agency’s administrative claims. The settlement also resolves three lawsuits filed under the whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the United States for false claims and share in a portion of the government’s recovery. The Act permits the United States to intervene in such a lawsuit, as it did in the three whistleblower cases filed against the defendants. These cases were subsequently transferred to the Western District of Missouri and consolidated with the government’s pending action. The amount to be recovered by the private whistleblowers has not yet been determined.

Jeffrey Newman represents whistleblowers but not those in this case.

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Genesis Healthcare Inc. (Genesis) will pay the federal government $53,639,288.04, including interest, to settle six federal lawsuits and investigations alleging that companies and facilities acquired by Genesis violated the False Claims Act by causing the submission of false claims to government health care programs for medically unnecessary therapy and hospice services, and grossly substandard nursing care. Genesis, headquartered in Kennett Square, Pennsylvania, owns and operates through its subsidiaries skilled nursing facilities, assisted/senior living facilities, and a rehabilitation therapy business.

This settlement resolves four sets of allegations. First, the settlement resolves allegations that from April 1, 2010 through March 31, 2013, Skilled Healthcare Group Inc. (SKG) and its subsidiaries, Skilled Healthcare LLC (Skilled LLC) and Creekside Hospice II LLC, knowingly submitted or caused to be submitted false claims to Medicare for services performed at the Creekside Hospice facility in Las Vegas, Nevada by: (1) billing for hospice services for patients who were not terminally ill and so were not eligible for the Medicare hospice benefit and (2) billing inappropriately for certain physician evaluation management services.

Second, this settlement resolves allegations that from Jan. 1, 2005 through Dec. 31, 2013, SKG and its subsidiaries, Skilled LLC and Hallmark Rehabilitation GP LLC, knowingly submitted or caused to be submitted false claims to Medicare, TRICARE, and Medicaid at certain facilities by providing therapy to certain patients longer than medically necessary, and/or billing for more therapy minutes than the patients actually received. The settlement also resolves allegations that those companies fraudulently assigned patients a higher Resource Utilization Group (RUG) level than necessary. Medicare reimburses skilled nursing facilities based on a patient’s RUG level, which is supposed to be determined by the amount of skilled therapy required by the patient.

Chemed Corp. the largest U.S. provider of hospice care is accused of defrauding the federal government by conspiring with health insurers to enroll Medicare patients who were not dying. The allegations were revealed in a whistleblower case taken by former employee. To be eligible for hospice, Medicare requires patients must have six months or less to live, certified by two doctors. Yet a patient can stay on hospice indefinitely, as long as a hospice doctor re-certifies their their terminal diagnosis every 60 days.