• Justice Department Increases Fraud Prosecution of Hospice Providers
  • May 15, 2013 | Author: Latour "LT" Lafferty
  • Law Firm: Fowler White Boggs P.A. - Tampa Office
  • The Justice Department announced filing a False Claim Act (FCA) lawsuit against Chemed Corporation, and various owned hospice subsidiaries, including Vitas Hospice Services LLC and Vitas Healthcare Corporation, the largest for-profit hospice chain in the United States, alleging false Medicare billings for hospice services. The announcement signals the continuing surge by federal prosecutors of FCA lawsuits, many of which originated as whistleblower complaints, against providers in the burgeoning hospice industry, utilizing the FCA which is the government’s chief civil fraud tool. The FCA allows private citizens with knowledge of fraud to file whistleblower suits on behalf of the United States and to share in any recovery, as well as authorizes treble damages and a penalty of $5,500 to $11,000 per false claim.

    The government prescribes that the Medicare hospice benefit is available for patients who have a life expectancy of six months or less if their disease runs its normal course. Patients admitted to a hospice stop receiving care to cure their illnesses and instead receive palliative care, or care that is aimed at relieving pain, symptoms or stress of terminal illness, which includes a comprehensive set of medical, social, psychological, emotional and spiritual services. “Medicare benefits, including the hospice benefits, are intended only for those individuals who are appropriately qualified,” said Joyce White Vance, U.S. Attorney for the Northern District of Alabama. “We must protect the public welfare and tax-funded benefits programs.” Medicare hospice care providers must obtain written certifications of terminal illness for each hospice beneficiary’s initial certification period (the first 90 days of care) from the medical director of the hospice and the individual beneficiary’s attending physician, if the beneficiary has one. Medicare requires a hospice to obtain these certifications prior to billing Medicare in order to help ensure that hospice care is medically necessary. “The Medicare hospice benefit is intended to provide patients nearing the end of life with pain management and other palliative care to make them as comfortable as possible,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division. “Too often, however, we hear reports of companies that abuse this critical service by using aggressive marketing tactics to push patients into services they don’t need in order to get higher reimbursements from the government. The Department of Justice will take swift action to protect taxpayer dollars and make sure that Medicare benefits are available to those who truly need them.”

    Over the last four years, federal prosecutors have asserted FCA claims against numerous hospice providers in addition to Chemed and obtained settlements including Golden Gate Ancillary LLC, dba AseraCare Hospice, Odyssey HealthCare, a subsidiary of Gentiva Healthcare ($25 million), Kaiser Foundation Hospitals - Kaiser Sunnyside Medical Center, Kaiser Foundation Health Plan of the Northwest and Northwest Permanente P.C., Physicians & Surgeons (collectively, Kaiser NW) ($1,830,322.41), Hospice of Arizona L.C., along with a related entity, American Hospice Management LLC, and their parent corporation, American Hospice Management Holdings LLC, ($12 million), Altus Healthcare & Hospice Inc. n/k/a AHH Historic Inc., of Atlanta, Georgia (Halcyon Healthcare) ($555,572), Hospice Home Care, Inc. ($2,700,000.00), SouthernCare Inc. ($24.7 million), Diakon Lutheran Social Ministries d/b/a Diakon Hospice Saint John (Diakon) ($10.56 million), Hospice Family Care, Inc. ($3,700,000), S-Hospice Group, Inc. d/b/a Home Hospice of North Texas (Home Hospice) ($500,000), Hospice Care of Kansas LLC and its parent company, Ft. Worth, Texas-based Voyager HospiceCare Inc., ($6.1 million), San Diego Hospice (bankruptcy), Harmony Care Hospice and its CEO Daniel J. Burton ($1.3 million), Hospice Care of Kansas LLC and Fort Worth-based Voyager HospiceCare Inc. ($6.1 million). Federal prosecutors have also asserted criminal charges against Good Samaritan Hospice USA Inc., resulted in a loss to the Medicare program of over $3 Million.

    According to James L. Santelle, U.S. Attorney for the Eastern District of Wisconsin, FCA settlements emphasize the governments’ “strong support of the qui tam or “whistleblower” process through which private individuals-often employees of offending health care providers-courageously come forward to report on waste, fraud, and abuse in the handling of taxpayer monies and beneficial programs.” Further, Mike Fields, Special Agent in Charge of Health and Human Services Office of the Inspector General (HHS-OIG) in Little Rock Arkansas added, “Any time greed replaces medical necessity as the primary factor in billing for medical services our most vulnerable citizens, the nation’s elderly, are imperiled. Our HHS OIG agents will continue to work closely with our law enforcement partners to investigate providers who loot the Medicare Trust fund. This settlement represents a significant recovery for taxpayers and should deter similar conduct in the future.”

    These settlements are part of the government’s continuing emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover $10.2 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $14 billion. Notably, the Middle District of Florida, which encompasses Tampa, Orlando, Jacksonville and Ft. Myers, has historically had one of the busiest whistleblower case dockets in the country, and in FY2012 placed seventh among the 94 judicial districts in cases filed under the False Claims Act.