“Hospice” has been defined as a “facility or program designed to provide a caring environment for meeting the physical and emotional needs of the terminally ill.” (Source) Medicare provides hospice care benefits to Medicare beneficiaries who have a terminal illness (a life expectancy of six months or less) if they decide on “palliative treatment,” which is care that is focused on providing patients with relief from pain and stress instead of medical treatment focused on curing the disease itself.
Hospice care and curative care are mutually exclusive benefits under Medicare provisions — a patient is entitled to Medicare benefits for either curative care (medical treatment intended to treat and cure a patient’s illness) or palliative treatment in a hospice facility, but not both.
Hospice treatment may be provided in either non-profit or for-profit hospice facilities. A for-profit hospice facility in Florida called Hospice of the Comforter Inc. (“HOTCI”) was subject to a whistleblower lawsuit filed by a private individual that alleges that HOTCI knowingly submitted false claims to Medicare for hospice care for patients who were not terminally ill. Specifically, the lawsuit contends that HOTCI’s chief executive officer verbally instructed HOTCI employees to admit Medicare recipients for hospice care even where there had not yet been a determination that they were eligible for the hospice benefit.
The whistleblower lawsuit also alleges that, after being notified that it would be audited by its Medicare contractor, HOTCI formed an internal committee to review the eligibility of its Medicare patients and discharged at least 150 patients in 2009-2010 as being ineligible for the Medicare hospice benefit.
The whistleblower lawsuit was filed under the U.S. False Claims Act (known as a qui tam action) that permits private individuals to file whistleblower lawsuits on behalf of the United States for submitting false claims to governmental agencies and entities. Under the False Claims Act, the so-called whistleblowers are entitled to receive a share of the funds that are recovered through their efforts as an incentive for filing such cases.
The False Claims Act permits the United States to intervene in the False Claims Act lawsuit and take over the litigation. The United States is entitled to recover three times the amount of the fraudulent claims as well as civil penalties from the offending parties under the False Claims Act.
The United States government recently intervened in the whistleblower case filed against HOTCI. In announcing the government’s intervention, the Acting Assistant Attorney General for the Civil Division of the Department of Justice stated, “The hospice benefit is intended only for people who qualify for and require such care. We will continue to protect this important component of the Medicare program by ensuring that entities providing hospice care are only treating, and billing for, qualified patients.”
The local U.S. Attorney for the Middle District of Florida noted that “Some of the most vulnerable people in our district rely on hospice services. It is critically important that Medicare remains solvent in order to provide hospice benefits, and that we confront those whose practices in this area put economic gain before patient care.”
If you may have information regarding false claims having been submitted to the United States, you may be entitled to receive a portion of the recovery that the United States receives if you bring a qui tam action on behalf of the United States under the False Claims Act. It is important that you seek the advice of an attorney experienced in qui tam lawsuits to learn about your responsibilities and rights with regard to the claim(s).
Click here to visit our website or telephone us toll-free at 800-295-3959 to be connected with qui tam lawyers (false claims lawyers) who may be able to assist you with a possible whistleblower claim.
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