Atlanta Hospice Reaches Settlement Involving False Claims Act Medicare/Medicaid Fraud

The United States has reached a settlement in a False Claims Act/whistleblower suit against Altus Healthcare & Hospice Inc. — now known as AHH Historic Inc. — of Atlanta, Georgia. Altus has agreed to pay $555,572 to settle False Claims Act allegations that the hospice provider submitted fraudulent claims to Medicaid and Medicare for inpatient hospice services, according to an article on LoanSafe.org dated July 18, 2012.

A Medicare or Medicaid patient with a terminal diagnosis who is expected to live six months or less is eligible for hospice benefits. The government health care programs recognize four levels of hospice care. Each level of care receives a different per diem reimbursement rate. The second highest level of reimbursement is general inpatient care. To be eligible for that level of inpatient care, a hospice patient must require acute or chronic symptom management or pain control that cannot be administered in an outpatient setting. The government alleged that from 2008 to 2010, Altus made false claims to Medicare for general inpatient care for hospice patients who were ineligible for that level of care. From 2008 to 2011, Altus was alleged to have submitted fraudulent claims to Medicaid.

As noted by United States Attorney Sally Quillian Yates: “The hospice benefit is intended to provide end-of-life care to terminally ill patients. . . . When a hospice bills Medicare and Medicaid for more expensive services than are warranted, it diverts funds that could be spent caring for patients who truly need that level of care.”

The allegations of fraud were revealed in a False Claims Act lawsuit originally filed by David C. Boal, a whistleblower, in the Northern District of Georgia. The qui tam provisions of the False Claims Act encourage private individuals to report fraudulent schemes against the government by allowing whistleblowers to share in a portion of the government’s recovery.

Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

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