In today’s case, we explore a somewhat increasing phenomenon of unlawful and fraudulent billing practices pertaining to palliative (i.e., end of life) care. When it comes to palliative care, Medicaid and Medicare enrollees may receive coverage for hospice services as long as certain criteria are met. Namely, there must be certification from a doctor that the patient is suffering from a terminal condition likely to result in the natural end of life within six months. Additionally, once a patient is classified as end-of-life, doctors and nurses are no longer meant to perform rehabilitative or curative procedures on the patient, and are only to make the patient comfortable and at peace during the end-of-life process.
According to the allegations upon which today’s case is based, Good Shepherd Hospice Inc., Good Shepherd Hospice of Mid America Inc., Good Shepherd Hospice, Wichita, L.L.C., Good Shepherd Hospice, Springfield, L.L.C., and Good Shepherd Hospice – Dallas L.L.C. (collectively Good Shepherd) engaged in the routine and consistent practice of admitting patients to its clinics that were not terminal and were not reaching end-of-life. Allegedly, Good Shepherd did this in order to pad profits and maximize revenue at the expense of taxpayers. As a result, a $4 million settlement has been reached.
Details of the Allegations Against Good Shepherd
Good Shepherd is a for-profit hospice company in the business of providing palliative care to terminal patients, including those receiving benefits through Medicare and Medicaid. As such, it must follow the above-described admittance guidelines in order to receive reimbursement for its services. According to the government’s allegations, Good Shepherd designed an incentive program to encourage nurses, staff, and even marketing employees to admit a certain numbers of hospice patients per day. In so doing, Good Shepherd regularly admitted patients who were not terminally ill and were not expected to pass away from their condition within six months or less.
Moreover, the company allegedly hired medical doctors with strong ties to nursing homes, seeing this nexus as a potentially lucrative admittance opportunity. Lastly, the government contends that Good Shepherd did not engage in standard training practices and its staff was not made aware of the Medicaid and Medicare hospice care eligibility criteria.
The case was brought to light by two former employees of the Good Shepherd group and both will share a $680,000 qui tam reward.
Response and Reaction From Government Officials
Hospice care resources are allocated for those who are suffering the effects of a terminal illness and government officials reacted strongly to the fraudulent submission of claims for reimbursement by Good Shepherd. The Department of Health and Human Services said in a statement:
“Being a hospice provider in the Medicare program is a privilege….Hospice providers that seek to boost profits by providing hospice services to Medicare beneficiaries who are not terminally ill compromise both the health of its patients, as well as the integrity of Medicare. Our agency will continue to hold such hospice providers accountable for their actions.”
The U.S. Attorney’s Office for the Western District of Missouri also commented, stating:
“Health care fraud puts profits above patients, and steals from taxpayers….In this case, company whistleblowers alleged that patients received unnecessary hospice care while Good Shepherd engaged in illicit business practices to enrich itself at the public’s expense. Today’s settlement fairly resolves those issues and puts measures in place to prevent similar conduct in the future.”
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