Hospice Fraud - A retell For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms

Attorney - Hospice Fraud - A retell For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms

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Hospice fraud in South Carolina and the United States is an expanding problem as the whole of hospice patients has exploded over the past few years. From 2004 to 2008, the whole of patients receiving hospice care in the United States grew approximately 40% to nearly 1.5 million, and of the 2.5 million citizen who died in 2008, nearly one million were hospice patients. The extraordinary majority of citizen receiving hospice care receive federal benefits from the federal government through the Medicare or Medicaid programs. The health care providers who provide hospice services traditionally enroll in the Medicare and Medicaid programs in order to qualify to receive payments under these government programs for services rendered to Medicare and Medicaid eligible patients.

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While most hospice health care organizations provide suitable and ethical treatment for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may supervene in the payments of large sums of money from the federal government, there are vast opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As up-to-date federal hospice fraud enforcement actions have demonstrated, the whole of health care fellowships and individuals who are willing to try to defraud the Medicare and Medicaid hospice benefits programs is on the rise.

A up-to-date example of hospice fraud appealing a South Carolina hospice is Southern Care, Inc., a hospice firm that in 2009 paid .7 million to determine an Fca case. The defendant operated hospices in 14 other states, too, together with Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, to wit, were not terminally ill, lack of documentation of terminal illnesses, and that the firm marketed to possible patients with the promise of free medications, supplies, and the provision of home health aides. Southern Care also entered into a 5-year Corporate Integrity trade with the Oig as part of the settlement. The qui tam relators received approximately million.

Understanding the Consequences of Hospice Fraud and Whistleblower Actions

U.S. And South Carolina consumers, together with hospice patients and their house members, and health care employees who are employed in the hospice industry, as well as their Sc lawyers and attorneys, should tip off themselves with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and hospice fraud schemes that have industrialized over the country. Consumers need to protect themselves from unethical hospice providers, and hospice employees need to guard against knowingly or unwittingly participating in health care fraud against the federal government because they may branch themselves to menagerial sanctions, together with lengthy exclusions from working in an club which receives federal funds, vast civil monetary penalties and fines, and criminal sanctions, together with incarceration. When a hospice worker discovers fraudulent escort appealing Medicare or Medicaid billings or claims, the worker should not share in such behavior, and it is imperative that the unlawful escort be reported to law enforcement and/or regulatory authorities. Not only does reporting such fraudulent Medicare or Medicaid practices shield the hospice worker from exposure to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may advantage financially under the reward provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States.

Types of Hospice Care Services

Hospice care is a type of health care service for patients who are terminally ill. Hospices also provide support services for the families of terminally ill patients. This care includes bodily care and counseling. Hospice care is normally provided by a collective agency or incommunicable firm approved by Medicare and Medicaid. Hospice care is available for all age groups, together with children, adults, and the elderly who are in the final stages of life. The purpose of hospice is to provide care for the terminally ill outpatient and his or her house and not to cure the terminal illness.

If a outpatient qualifies for hospice care, the outpatient can receive curative and support services, together with nursing care, curative collective services, physician services, counseling, homemaker services, and other types of services. The hospice outpatient will have a team of doctors, nurses, home health aides, collective workers, counselors and trained volunteers to help the outpatient and his or her house members cope with the symptoms and consequences of the terminal illness. While many hospice patients and their families can receive hospice care in the relax of their home, if the hospice patient's health deteriorates, the outpatient can be transferred to a hospice facility, hospital, or nursing home to receive hospice care.

Hospice Care Statistics

The whole of days that a outpatient receives hospice care is often referenced as the "length of stay" or "length of service." The distance of service is dependent on a whole of separate factors, together with but not slight to, the type and stage of the disease, the ability of and passage to health care providers before the hospice referral, and the timing of the hospice referral. In 2008, the median distance of stay for hospice patients was about 21 days, the median distance of stay was about 69 days, approximately 35% of hospice patients died or were discharged within 7 days of the hospice referral, and only about 12% of hospice patients survived longer than 180 days.

Most hospice care patients receive hospice care in incommunicable homes (40%). Other locations where hospice services are provided are nursing homes (22%), residential facilities (6%), hospice outpatient facilities (21%), and acute care hospitals (10%). Hospice patients are ordinarily the elderly, and hospice age group percentages are 34 years or less (1%), 35 - 64 years (16%), 65 - 74 years (16%), 75 - 84 years (29%), and over 85 years (38%). As for the terminal illness resulting in a hospice referral, cancer is the analysis for approximately 40% of hospice patients, followed by debility unspecified (15%), heart disease (12%), dementia (11%), lung disease (8%), stroke (4%) and kidney disease (3%). Medicare pays the great majority of hospice care expenses (84%), followed by incommunicable insurance (8%), Medicaid (5%), charity care (1%) and self pay (1%).

As of 2008, there were approximately 4,700 locations which were providing hospice care in the United States, which represented about a 50% increase over ten years. There were about 3,700 fellowships and organizations which were providing hospice services in the United States. About half of the hospice care providers in the United States are for-profit organizations, and about half are non-profit organizations.
General overview of the Medicare and Medicaid Programs

In 1965, Congress established the Medicare schedule to provide health insurance for the elderly and disabled. Payments from the Medicare schedule arise from the Medicare Trust fund, which is funded by government contributions and through payroll deductions from American workers. The Centers for Medicare and Medicaid Services (Cms), previously known as the health Care Financing supervision (Hcfa), is the federal agency within the United States agency of health and Human Services (Hhs) that administers the Medicare schedule and works in partnership with state governments to administer Medicaid.

In 2007, Cms reorganized its ten geography-based field offices to a Consortia structure based on the agency's key lines of business: Medicare health plans, Medicare financial management, Medicare fee for service operations, Medicaid and children's health, recognize & certification and ability improvement. The Cms consortia consist of the following:

• Consortium for Medicare health Plans Operations
• Consortium for Financial supervision and Fee for service Operations
• Consortium for Medicaid and Children's health Operations
• Consortium for ability correction and recognize & Certification Operations

Each consortium is led by a Consortium Administrator (Ca) who serves as the Cms's national focal point in the field for their firm line. Each Ca is responsible for consistent implementation of Cms programs, policy and guidance over all ten regions for matters pertaining to their firm line. In expanding to accountability for a firm line, each Ca also serves as the Agency's senior supervision official for two or three Regional Offices (Ros), representing the Cms Administrator in external matters and overseeing menagerial operations.

Much of the daily supervision and doing of the Medicare schedule is managed through incommunicable insurance fellowships that ageement with the Government. These incommunicable insurance companies, sometimes called "Medicare Carriers" or "Fiscal Intermediaries," are charged with and responsible for accepting Medicare claims, determining coverage, and development payments from the Medicare Trust Fund. These carriers, together with Palmetto Government Benefits Administrators (hereinafter "Pgba"), a agency of Blue Cross and Blue Shield of South Carolina, control pursuant to 42 U.S.C. §§ 1395h and 1395u and rely on the good faith and truthful representations of health care providers when processing claims.

Over the past forty years, the Medicare schedule has enabled the elderly and disabled to obtain valuable curative services from curative providers throughout the United States. valuable to the success of the Medicare schedule is the basic conception that health care providers accurately and categorically submit claims and bills to the Medicare Trust Fund only for those curative treatments or services that are legitimate, reasonable and medically necessary, in full compliancy with all laws, regulations, rules, and conditions of participation, and, further, that curative providers not take advantage of their elderly and disabled patients.

The Medicaid schedule is available only to clear low-income individuals and families who must meet eligibility requirements set forth by federal and state law. Each state sets its own guidelines about eligibility and services. Although administered by personel states, the Medicaid schedule is funded primarily by the federal government. Medicaid does not pay money to patients; rather, it sends payments directly to the patient's health care providers. Like Medicare, the Medicaid schedule depends on health care providers to accurately and categorically submit claims and bills to schedule administrators only for those curative treatments or services that are legitimate, reasonable and medically necessary, in full compliancy with all laws, regulations, rules, and conditions of participation, and, further, that curative providers not take advantage of their indigent patients.

Medicare & Medicaid Hospice Laws Which affect Sc Hospices

Hospice fraud occurs when hospice organizations, by and through their employees, agents and owners, knowingly violate the terms and conditions of the applicable Medicare and Medicaid hospice statutes, regulations, rules and conditions of participation. In order to be able to recognize hospice fraud, hospices, hospice patients, hospice employees and their attorneys and lawyers must know the Medicare laws and requirements relating to hospice care benefits.

Medicare's two main sources of authorization for hospice benefits are found in the collective safety Act and the U.S. Code of Federal Regulations. The statutory provisions are primarily found at 42 U.S.C. §§ 1395d, 1395e, 1395f(a)(7), 1395x(d)(d), and 1395y, and the regulatory provisions are found at 42 C.F.R. Part 418.

To be eligible for Medicare benefits for hospice care, the outpatient must be eligible for Medicare Part A and be terminally ill. 42 C.F.R. § 418.20. terminal illness is established when "the personel has a curative analysis that his or her life expectancy is 6 months or less if the illness runs its normal course." 42 C.F.R. § 418.3; 42 U.S.C. § 1395x(d)(d)(3). The patient's physician and the curative director of the hospice must certify in writing that the outpatient is "terminally ill." 42 U.S.C. § 1395f(a)(7); 42 C.F.R. § 418.20. After a patient's initial certification, Medicare provides for two ninety-day advantage periods followed by an unlimited whole of sixty-day advantage periods. 42 U.S.C. § 1395d(a)(4). At the end of each ninety- or sixty-day period, the outpatient can be re-certified only if at that time he or she has less than six months to live if the illness runs its normal course. 42 U.S.C. § 1395f(a)(7)(A). The written certification and re-certifications must be maintained in the patient's curative records. 42 C.F.R. § 418.23. A written plan of care must be established for each outpatient setting forth the types of hospice care services the outpatient is scheduled to receive, 42 U.S.C. § 1395f(a)(7)(B), and the hospice care has to be provided in accordance with such plan of care. 42 U.S.C. § 1395f(a)(7)(C); 42 C.F.R. § 418.56. Clinical records for each hospice outpatient must be maintained by the hospice, together with plan of care, assessments, clinical notes, signed observation of election, outpatient responses to medication and therapy, physician certifications and re-certifications, outcome data, enlarge directives and physician orders. 42 C.F.R. § 418.104.

The hospice must obtain a written observation of election from the outpatient to elect to receive Medicare hospice benefits. 42 C.F.R. § 418.24. Importantly, once a outpatient has elected to receive hospice care benefits, the outpatient waives Medicare benefits for curative treatment for the terminal disease upon which is the admitting diagnosis. 42 C.F.R. § 418.24(d).

The hospice must prescribe an Interdisciplinary Group (Idg) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. 42 C.F.R. § 418.56. The Idg members must provide the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. A registered nurse that is a member of the Idg must be designated to provide coordination of care and to ensure continuous estimate of each patient's and family's needs and implementation of the interdisciplinary plan of care. The interdisciplinary group must include, but is not slight to, the following fine and competent professionals: (i) A physician of treatment or osteopathy (who is an worker or under ageement with the hospice); (ii) A registered nurse; (iii) A collective worker; and, (iv) A pastoral or other counselor. 42 C.F.R. § 418.56.

The Medicare hospice regulations, at 42 C.F.R. § 418.200, summarize the requirements for hospice coverage in pertinent part as follows:

To be covered, hospice services must meet the following requirements. They must be reasonable and valuable for the palliation and supervision of the terminal illness as well as linked conditions. The personel must elect hospice care in accordance with §418.24. A plan of care must be established and periodically reviewed by the attending physician, the curative director, and the interdisciplinary group of the hospice schedule as set forth in §418.56. That plan of care must be established before hospice care is provided. The services provided must be consistent with the plan of care. A certification that the personel is terminally ill must be completed as set forth in section §418.22.

The collective safety Act, at 42 U.S.C. § 1395y(a), limits Medicare hospice benefits, providing in pertinent part as follows: "Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services-... (C) in the case of hospice care, which are not reasonable and valuable for the palliation or supervision of terminal illness...." 42 C.F.R. § 418.50 (hospice care must be "reasonable and valuable for the palliation and supervision of terminal illness"). Palliative care is defined in the regulations as "patient and family-centered care that optimizes ability of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate outpatient autonomy, passage to information, and choice." 42 C.F.R. § 418.3.

Medicare pays hospice agencies a daily rate for each day a beneficiary is enrolled in the hospice advantage and receives hospice care. The daily payments are made regardless of the whole of services furnished on a given day and are intended to cover costs that the hospice incurs in furnishing services identified in the patient's plan of care. There are four levels of payments which are made based on the whole of care required to meet beneficiary and house needs. 42 C.F.R. § 418.302; Cms Hospice Fact Sheet, November 2009. These four levels, and the corresponding 2010 daily rates, are as follows: habit home care (2.91); continuous home care (4.10); outpatient respite care (7.83); and, normal outpatient care (5.74).

The combination every year cap per outpatient in 2009 was ,014.50. This cap is carefully by adjusting the primary hospice outpatient cap of ,500, set in 1984, by the buyer Price Index. See Cms Internet-Only by hand 100-04, lesson 11, section 80.2; 42 U.S.C. § 1395f(i); 42 C.F.R. § 418.309. The Medicare Claims Processing Manual, at lesson 11 - Processing Hospice Claims, in Section 80.2, entitled "Cap on total Hospice Reimbursement," provides in pertinent part as follows: "Any payments in excess of the cap must be refunded by the hospice."

Hospice patients are responsible for Medicare co-insurance payments for drugs and respite care, and the hospice may fee the outpatient for these co-insurance payments. However, the co-insurance payments for drugs are slight to the lesser of or 5% of the cost of the drugs to the hospice, and the co-insurance payments for respite care are ordinarily 5% of the payment made by Medicare for such services. 42 C.F.R. § 418.400.

The Medicare and Medicaid programs want institutional health care providers, together with hospice organizations, to file an enrollment application in order to qualify to receive the programs' benefits. As part of these enrollment applications, the hospice providers certify that they will comply with Medicare and Medicaid laws, regulations, and schedule instructions, and added certify that they understand that payment of a claim by Medicare and Medicaid is conditioned upon the claim and basic transaction complying with such schedule laws and requirements. The Medicare Enrollment Application which hospice providers must execute, Form Cms-855A, states in part as follows: "I agree to abide by the Medicare laws, regulations and schedule instructions that apply to this provider. The Medicare laws, regulations, and schedule instructions are available through the Medicare contractor. I understand that payment of a claim by Medicare is conditioned upon the claim and the basic transaction complying with such laws, regulations, and schedule instructions (including, but not slight to, the Federal Aks and Stark laws), and on the provider's compliancy with all applicable conditions of participation in Medicare."

Hospices are ordinarily required to bill Medicare on a monthly basis. See the Medicare Claims Processing Manual, at lesson 11 - Processing Hospice Claims, in Section 90 - Frequency of Billing. Hospices ordinarily file their hospice Medicare claims with their Fiscal Intermediary or Medicare Carrier pursuant to the Cms Claims by hand Form Cms 1450 (sometime also called a Form Ub-04 or Form Ub-92), whether in paper or electronic form. These claim forms comprise representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of valuable facts may serve as the basis for civil monetary penalties and criminal convictions; (2) submission of the claim constitutes certification that the billing facts is true, spoton and complete; (3) the submitter did not knowingly or recklessly disregard or misrepresent or conceal material facts; (4) all required physician certifications and re-certifications are on file; (5) all required outpatient signatures are on file; and, (6) for Medicaid purposes, the submitter understands that because payment and pleasure of this claim will be from Federal and State funds, any false statements, documents, or concealment of a material fact are branch to prosecution under applicable Federal or State Laws.

Hospices must also file with Cms an every year cost and data record of Medicare payments received. 42 U.S.C. § 1395f(i)(3); 42 U.S.C. § 1395x(d)(d)(4). The every year hospice cost and data reports, Form Cms 1984-99, comprise representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of facts contained in the cost record may be punishable by criminal, civil and menagerial actions, together with fines and/or imprisonment; (2) if any services identified in the record were the goods of a direct or indirect kickback or were otherwise illegal, then criminal, civil and menagerial actions may result, together with fines and/or imprisonment; (3) the record is a true, spoton and complete statement ready from the books and records of the victualer in accordance with applicable instructions, except as noted; and, (4) the signing officer is well-known with the laws and regulations about the provision of health care services and that the services identified in this cost record were provided in compliancy with such laws and regulations.

Hospice Anti-Fraud enforcement Statutes

There are a whole of federal criminal, civil and menagerial enforcement provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, together with hospice fraud, and which help verbalize schedule integrity and compliance. Some of the more leading enforcement provisions of the Medicare statutes comprise the following: 42 U.S.C. § 1320a-7b (Criminal fraud and anti-kickback penalties); 42 U.S.C. § 1320a-7a and 42 U.S.C. § 1320a-8 (Civil monetary penalties for fraud); 42 U.S.C. § 1320a-7 (Administrative exclusions from participation in Medicare/Medicaid programs for fraud); 42 U.S.C. § 1320a-4 (Administrative subpoena power for the Comptroller General).

Other criminal enforcement provisions which are used to combat Medicare and Medicaid fraud, together with hospice fraud, comprise the following: 18 U.S.C. § 1347 (General health care fraud criminal statute); 21 U.S.C. §§ 353, 333 (Prescription Drug Marketing Act); 18 U.S.C. § 669 (Theft or Embezzlement in connection with health Care); 18 U.S.C. § 1035 (False statements relating to health Care); 18 U.S.C. § 2 (Aiding and Abetting); 18 U.S.C. § 3 (Accessory after the Fact); 18 U.S.C. § 4 (Misprision of a Felony); 18 U.S.C. § 286 (Conspiracy to defraud the Government with respect to Claims); 18 U.S.C. § 287 (False, Fictitious or Fraudulent Claims); 18 U.S.C. § 371 (Criminal Conspiracy); 18 U.S.C. § 1001 (False Statements); 18 U.S.C. § 1341 (Mail Fraud); 18 U.S.C. § 1343 (Wire Fraud); 18 U.S.C. § 1956 (Money Laundering); 18 U.S.C. § 1957 (Money Laundering); and, 18 U.S.C. § 1964 (Racketeer Influenced and Corrupt Organizations ("Rico")).

The False Claims Act (Fca)

Hospice fraud whistleblowers may advantage financially under the reward provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States. The plaintiff in a hospice fraud whistleblower suit is also known as a relator. The most common Fca provisions upon which hospice fraud qui tam or whistleblower relators rely are found in 31 U.S.C. § 3729: (A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval; (B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim; (C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);..., and, (G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an enforcement to pay or send money or asset to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an enforcement to pay or send money or asset to the Government.... There is no requirement to prove exact intent to defraud. Rather, it is only valuable to prove actual knowledge of the false claims, false statements, or false records, or the defendant's deliberate indifference or reckless disregard of the truth or falsity of the information. 31 U.S.C. § 3729(b).

The Fca anti-retaliation provision protects the hospice whistleblower from retaliation from the hospice when the worker (or a contractor) "is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment" for taking activity to try to stop the fraudulent activity. 31 U.S.C. § 3730(h). A hospice employee's relief includes reinstatement, 2 times the whole of back pay, interest on the back pay, and compensation for any extra damages sustained as a supervene of the discrimination or retaliation, together with litigation costs and reasonable attorneys' fees.

A Sc hospice fraud Fca whistleblower would initially file a disclosure statement, complaint and supporting documents with the U.S. Attorney's Office in Columbia, South Carolina, and the Us Attorney General. After the disclosures are filed, a federal court complaint can be filed. The Sc agency where the frauds occurred, the relator's residence, and the defendant residence, will determine which agency the case will be assigned. There are eleven federal court divisions in South Carolina. Once the case has been filed, the government has 60 days to determine whether or not to intervene. While this time, federal government investigators settled in South Carolina will research the claims. If the case complicated Medicaid, Sc Medicaid fraud unit investigators will likely become complicated as well. If the government intervenes in the case, the U.S. Attorney for South Carolina is normally the lead attorney. If the government does not intervene, the relator's Sc attorney will prosecute the case. In South Carolina, expect a qui tam case to take one to two years to get to trial.

Tips on Recognizing Hospice Fraud Schemes

The Hhs Office of Inspector normal (Oig) has issued extra Fraud Alerts for fraudulent and abusive practices of hospices. U.S. And South Carolina hospices, patients, hospice employees and whistleblowers, their attorneys and lawyers, should be well-known with these hospice fraud practices. Tips on recognizing hospice frauds in South Carolina and the U.S. Are:

• A hospice contribution free goods or goods at below market value to induce a nursing home to refer patients to the hospice.
• False representations in a hospice's Medicare/Medicaid enrollment form.
• A hospice paying "room and board" payments to the nursing home in amounts in excess of what the nursing home would have received directly from Medicaid had the outpatient not been enrolled in the hospice.
• False statements in a hospice's claim form (Cms Forms 1450, Ub-04 or Ub-92).
• A hospice falsely billing for services that were not reasonable or valuable for the palliation of the symptoms of a terminally ill patient.
• A hospice paying amounts to the nursing home for "additional" services that Medicaid carefully included in its room and board payment to the hospice.
• A hospice paying above fair market value for "additional" non-core services which Medicaid does not reconsider to be included in its room and board payments to the nursing home.
• A hospice referring patients to a nursing home to induce the nursing home to refer its patients to the hospice.
•A hospice providing free (or below fair market value) care to nursing home patients, for whom the nursing home is receiving Medicare payment under the skilled nursing facility benefit, with the hope that after the outpatient exhausts the skilled nursing facility benefit, the outpatient will receive hospice services from that hospice.
• A hospice providing staff at its expense to the nursing home to achieve duties that otherwise would be performed by the nursing home.
• Incomplete or no written Plan of Care was established or reviewed at exact intervals.
• Plan of Care did not comprise an estimate of needs.
• Fraudulent statements in a hospice's cost record to the government.
• observation of election was not obtained or was fraudulently obtained.
• Rn supervisory visits were not made for home health aide services.
• Certification or Re-certification of terminal illness was not obtained or was fraudulently obtained.
• No Plan of care was included for bereavement services.
• Fraudulent billing for upcoded levels of hospice care.
• Hospice did not escort a self-assessment of ability and care provided.
• Clinical records were not maintained for every patient.
• Interdisciplinary group did not chronicle and update the plan of care for each patient.

Recent Hospice Fraud enforcement Cases

The Doj and U.S. Attorney's Offices have been active in enforcing hospice fraud cases.

In 2009, Kaiser Foundation Hospitals settled an Fca lawsuit by paying .8 million to the federal government. The defendant assertedly failed to obtain written certifications of terminal illness for a whole of its patients.

In 2006, Odyssey Healthcare, a national hospice provider, paid .9 million to determine a qui tam suit for false claims under the Fca. The hospice fraud allegations were ordinarily that Odyssey billed Medicare for providing hospice care to patients when they were not terminally ill and ineligible for Medicare hospice benefits. A Corporate Integrity trade was also a part of the settlement. The hospice fraud qui tam relator received .3 million for blowing the whistle on the defendant.

In 2005, Faith Hospice, Inc., settled claims an Fca claim for 0,000. The hospice fraud allegations were ordinarily that Faith Hospice billed Medicare for providing hospice care to patients more than half of whom were not terminally ill.

In 2005, Home Hospice of North Texas settled an Fca claim for 0,000 about allegations of fraudulently billing Medicare for ineligible hospice patients.

In 2000, Michigan osteopath Donald Dreyfuss, who pleaded guilty to criminal fraud charges, together with violation of the Aks for receiving illegal kickbacks from a hospice for recommending the hospice to the staff of his nursing home, settled an Fca suit for million.

Conclusion

Hospice fraud is a growing problem in South Carolina and throughout the United States. South Carolina hospice patients, hospice employees, and their Sc lawyers and attorneys, should be well-known with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and typical hospice fraud schemes. Hospice organizations should take steps to ensure full compliancy with Medicare/Medicaid hospice billing requirements to avoid hospice fraud allegations and Fca litigation.

© 2010 Joseph P. Griffith, Jr.

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