Hospice care fraud can take a variety of forms, ranging from not providing required services, improperly admitting patients, to kickbacks for patient referrals. The U.S. Department of Justice has filed several cases against many different home health care providers in relation to hospice fraud.
What is Hospice Care?
Hospice care is a form of home health care intended for terminally ill patients. Patients in hospice care no longer receive curative treatments and are instead given palliative care to make them comfortable in their final days. For a patient to be eligible to receive hospice care, a physician must determine the care is necessary and must certify that the patient’s life expectancy is six months or less.
Defrauding the Government
In many of the cases filed by the DOJ, home healthcare companies were admitting patients into hospice who were not terminally ill. These companies targeted patients who were on Medicare since hospice benefits under Medicare are some of the highest reimbursements that Medicare pays out. Medicare pays for each day the beneficiary receives hospice care. There are varying levels of hospice care, but claims for continuous home care are the most expensive compared to routine hospice services.
This type of fraud is extremely disturbing. When home healthcare companies unnecessarily admit patients who are not terminally ill into hospice care, the patients no longer receive treatments for recovery. In other words, these patients should be receiving lifesaving treatments, but are instead receiving end-of-life palliative care. Companies and physicians who are motivated by greed are putting the lives of patients at risk in order to line their own pockets.
Hospice fraud also occurs in patients-for-kickbacks schemes. The government has filed cases in which home healthcare companies paid kickbacks to marketers, doctors, and other medical staff in exchange for patient referrals. Under federal law, it is illegal for any person to knowingly solicit, offer, or pay a kickback, bribe, or rebate for furnishing services under a federal healthcare program. In these cases, many of the patients are insured by Medicare, which is a taxpayer-funded insurance program, so kickback schemes are illegal.
What Can You Do to Help?
Individuals with firsthand knowledge of government fraud can speak to a whistleblower attorney and bring a lawsuit on behalf of the federal government for false claims. The whistleblower can also share in the recovery.
Healthcare and hospice employees are critical in combating hospice fraud. If you are aware of hospice fraud, you may qualify to serve as a whistleblower. Baron & Budd’s experienced whistleblower representation team has helped numerous whistleblowers achieve a successful resolution in a wide variety of cases under state and federal law. Please call (866) 401-5971 if you want to report hospice fraud.