As we have previously reported on this blog, hospice care fraud is one of the major emerging trends facing the federal and state governments, costing millions of tax dollars annually in misspending and waste. In today’s case, we review a settlement involving a New York-based hospice center, which has agreed to pay $6.5 million to the state of New York and the federal government. Out of the settlement, the state of New York will receive $1.6 million, which is representative of its contribution.
The case was brought to light by a whistleblower who worked in the company’s Bronx, New York, location. However, the details of the whistleblower’s reward have not been publicly disclosed.
Allegations raised against Compassionate Care Hospice
Compassionate Care is a for-profit palliative care center in the practice of providing comfort and support to patients facing terminal illnesses and end-of-life conditions. For patients enrolled in public healthcare systems like Medicare or Medicaid, palliative care is only covered once the patient has been deemed terminal and likely to succumb to his or her illness within the next six months. Likewise, patients are only covered for pain management, nutritional support, and other services designed to keep the patient comfortable. Accordingly, patients are not eligible for reimbursement for services designed to cure the illness or mitigate its progression. And, like all other areas of medicine, certain criteria must be met by the center in terms of protocol, care standards, and care planning.
According to the allegations against Compassionate Care, several areas of regulation were violated within a period of time spanning from 2010 through 2011. More specifically, the New York Attorney General’s office released the following findings against the center:
- Failure to treat patients according to the pre-determined care plans
- Failure to maintain a required level of communication and integration between the multi-disciplinary care team
- Failure to make skilled nursing services available to patients seven days per week, 24 hours per day
- Failure to provide nursing services in accordance with patients’ care plans
- Failure to maintain adequate clinical records
- Failure to sufficiently supervise and oversee employees.
The bulk of the allegations against Compassionate Care Hospice occurred at its Bronx location; however, the company was cited for non-compliance at other facilities, as well.
The Attorney General’s office said in a statement, “Those who defraud Medicaid are looting from taxpayers and depriving vulnerable New Yorkers of important medical care, and my office will hold them accountable….Today’s settlement will recover the Medicaid funds that were improperly obtained, along with extra statutory damages.”
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