Under federal regulations, government healthcare programs like Medicare and Medicaid are only available to cover end-of-life services once a patient has reached a terminal point in their illness or injury. Unlike curative care, palliative care is only designed to make a patient more comfortable. Program regulations state that curative methods should not be used for patients receiving hospice services.
In a recent settlement from Phoenix, Arizona, Serenity Hospice and Palliative Care settled with the Department of Justice amid allegations that it wrongfully billed for hospice services despite findings that patients were not actually terminal. As a result of the settlement, the program and its director accepted a punitive measure effectively banning the center from participation in Medicare and Medicaid for a period of five years.
This case was originally filed in 2014 by the former clinical director of the facility. In exchange for her willingness to expose the fraud, she will receive $440,000 from the settlement.
Allegations against Serenity
According to the whistleblower’s allegations, Serenity Hospice instructed staff members to flag hospice center referrals from a specific area healthcare provider known as CareMore. CareMore patients were almost always admitted as palliative care patients regardless of the status of their medical conditions and regardless of whether end-of-life treatment was appropriate in their situations. In exchange, Serenity’s founder and former president, Ruth Siegel, allegedly treated CareMore staff to lavish trips, concerts, and entertainment.
The complaint further alleged that Serenity suspended unsuspecting patients’ curative care and administered therapeutic palliative care instead. Upon review of 15 randomly selected patient files, investigators concluded that many were not suffering from a terminal illness at the time of their admittance and were not considered to have six months or less to live – a requisite for coverage under Medicare or Medicaid.
The Department of Health and Human Services said in a statement, “Hospice providers and executives that seek to boost profits by providing hospice services to Medicare beneficiaries whose medical condition does not warrant hospice care compromise both the health of their patients as well as the integrity of Medicare.”
Siegel will personally pay $1 million to the federal government, and Serenity will forward the remaining $1.2 million. While Serenity has not admitted any liability or wrongdoing in the matter, its spokesperson recently stated, “The bottom line is we chose to settle so we can get back to what we do best, which is hospice work.”
Contact Berger Montague today
If you are considering a False Claims Act lawsuit and would like to discuss your options, please do not hesitate to contact Berger Montague, P.C. today.