The Department of Justice recently announced a $3.9 million settlement with a palliative care company responsible for operating a number of hospice care facilities in the Southeast United States. The case involves alleged fraudulent invoices to Medicare for end-of-life care that did not meet Medicare guidelines for coverage – thus meeting the definition of a false claim under the False Claims Act. As part of the Federal Government’s sizable settlement amount, the whistleblowers in the case received $712,000 for their willingness to come forward and report allegations of fraud.
Case Against Hospice Compassus
Medicare fraud is a rampant, nationwide problem plaguing the Federal Government and the states alike. While there are many ways in which a hospital or facility can engage in fraud, one of the most common practices involves billing for services that either were never rendered or for services that were actually rendered but billed at a higher rate than allowed. In today’s case, which involves Alabama-based Hospice Compassus, various hospice facilities were admitting Medicare patients for end-of-life care when their condition or prognosis did not meet Medicare guidelines for coverage.
Under current Medicare coverage guidelines, hospice and respite care coverage is offered only at the point when the patient no longer wishes to pursue curative treatment. In other words, the patient has decided to forgo trying to cure or reverse his illness and would rather be kept comfortable while they let their condition take its natural course. Patients have the right to stop hospice care at any time to pursue curative measures. However, in order to continue receiving end-of-life care coverage, the patient must be under a terminal prognosis and expected to live six months or less.
As the details emerge in the Medicare fraud case involving Hospice Compassus, the Department of Justice has revealed that Compassus was regularly submitting invoices for hospice care involving patients who did not meet the eligibility requirements and had not received the requisite terminal prognosis. While the exact details of Compassus’ violations have not been made public by the DOJ in its press release, other hospice centers have faced allegations in the past involving unnecessary medical interventions and treatments meant to bestow a curative, rather than palliative, effect on the patient’s condition. Other hospice cases have involved patient quota criteria set by management, resulting in the admission of patients who were not in need of end-of-life care.
U.S. Attorney Joyce Vance stated, “This settlement returns to taxpayers almost $4 million that was wrongfully claimed from Medicare by a company that offered hospice care in Alabama….The U.S. Attorney’s Office in North Alabama is committed to protecting public monies and safeguarding Medicare beneficiaries.”
Hospice Compassus responded to allegations by reiterating its dedication to compliance and integrity. Specifically, “Compassus is proud of the comprehensive compliance program that has been an integral part of our company from the day it was founded in 1979. Regulatory compliance is a pillar of our cultural foundation to which every colleague in the organization is committed….We are proud of the quality medical care and service provided by our colleagues and physicians and pleased to have resolved this matter.” The facility has not admitted liability or wrongdoing and chose to settle the matter in order to “avoid expense and distraction.”
Unlike many other healthcare fraud settlements, the DOJ did not require Hospice Compassus to engage in a corporate integrity agreement. Corporate integrity agreements are often used to deter a defendant from engaging in further fraud in the future and usually contain clauses promising the termination of the facility from enrollment in Medicare or Medicaid programs if found to be engaging in subsequent fraud.
Contact a Whistleblower Attorney Today
If you are aware of possible healthcare fraud in your place of employment or doctor’s office, we encourage you to meet with a whistleblower attorney as soon as possible. For more information about the qui tam process or how to get started with your case, call Berger Montague today!