Quality hospice care can be a source of reassuring comfort and support to terminally ill patients and their families. Yet, some companies are more concerned with profits than the well-being of patients. Steps must be taken to prevent not only the very human toll that hospice fraud takes, but also the economic toll as well. Hospice fraud is a particularly egregious breach of not only patient trust, but also has substantial financial impact.

Whistleblowers are key in the fight to prevent hospice fraud. They are needed to expose how hospices do not provide the services that patients need, provide poor-quality care, and do not provide patients and their families with crucial information to make fully informed decisions about hospice care.

Hospice Care and Medicare

Hospice care serves terminally ill beneficiaries who decide to forgo curative treatment for a terminal illness and instead receive palliative care. The Medicare hospice benefit aims to help patients live out their final days with dignity in peace and comfort.

Medicare-certified hospices provide the care. Hospices may be for-profit, nonprofit, or government-owned. Hospice care can be provided in different settings, including a patient’s residence, or places such as an assisted living facility, skilled nursing facility, or other nursing facility. Medicare pays by the day for each day the beneficiary receives hospice care. The daily payments depend on the level of hospice care provided: routine home care, general inpatient care, continuous home care, or inpatient respite care.

The Medicare hospice program has grown considerably in recent years. The number of hospices in the US increased by 43% between 2006 and 2016. Likewise, Medicare paid $16.7 billion for hospice care in 2016, an increase of 81% since 2006.

As with many government programs, the hospice benefit has become a target for fraudsters. Overall, Medicare fraud and inaccurate billing costs the federal government health care program as much as $60 billion annually. With the boom in end-of-life services, Medicare hospice fraud also has risen.

Hospice Fraud Cases

With the increase in hospice fraud, so too have enforcement actions increased against those committing the fraud. From fiscal years 2013 to 2017, government investigators won back $143.9 million from 25 criminal actions and 66 civil actions against hospices. Yet there is much more to be done.

A small sampling of recent and notable hospice fraud cases demonstrates the scope of the issue:

• Amity Home Health Care was charged by federal prosecutors with paying doctors in a Medicare kickback scheme involving $115 million. Amity’s employees were accused of bribing individuals associated with hospitals, skilled nursing facilities (SNFs) and doctors’ offices in the form of payroll, reimbursements, donations and gifts, according to DOJ. The criminal complaints describe how Amity and some of its employees bribed individuals associated with hospitals, skilled nursing facilities, and doctors’ offices to induce those individuals to send patients to Amity and Advent.  Amity and the other defendants often disguised the kickbacks as payroll, phony medical directorships, and, at other times, as “entertainment,” reimbursements,” “gifts”, or “donations.”  In addition, some of the defendants are described as “marketers.” Marketers received from Amity and others cash and gifts, such as tickets to Warriors games, in exchange for patient referrals.  Marketers had clients that consisted of case managers at hospitals, social workers at skilled nursing facilities, doctors, and office staff at doctors’ offices.
• Chemed Corporation agreed to pay $75 million to resolve allegations that its subsidiary, Vitas Hospice Services submitted or caused the submission of false claims to the Medicare program by (a) billing Medicare for continuous home care services when the patients were not eligible, the services were not provided, or the medical care was inappropriate, and (b) billing Medicare for patients who were not eligible for the Medicare hospice benefit because they did not have a life expectancy of six months or less if their illnesses ran their normal course. Vitas also entered into a five-year Corporate Integrity Agreement (CIA) with the HHS Office of Inspector General (HHS-OIG) to settle the agency’s administrative claims.

The cases above are just a couple of examples of the types of fraud that exists in the hospice community. For many hospice fraud cases, the fraud may take varied forms and in many instances it is up to diligent, honest healthcare employees to stand up for the hospice patients and their families.

How You Can Help

Healthcare employees are essential in combating hospice fraud. Be sure to trust your instincts. If something appears suspicious, make note and report it.

If you are aware of hospice fraud or have been approached with a proposal to commit fraud, you may qualify to serve as a whistleblower. Whistleblowers are protected by the law and can receive a portion of the recovery.

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) 845-2164 if you want to report hospice fraud.