December 11, 2013 — Our nation’s Medicare program is deluged every year with fraudulent claims filed by doctors, hospitals, hospice providers and other health care providers. To tackle the problem, the United States Justice Department counts on tips from health care employees working inside the industry. The False Claims Act incorporates qui tam provisions that empower conscientious informants to bring a lawsuit for the government. To incentivize whistleblowers to step forward, the Act entitles tipsters to a share of the government’s recovery.
Whistleblower Alleged That Orlando Hospice Provider Systematically Billed Medicare for Non-Terminal Patients Ineligible for Program Benefits
Hospice of the Comforter Inc. (HOTCI) near Orlando, Florida has consented to pay $3 million to settle False Claims Act allegations brought in a whistleblower lawsuit. Douglas Stone, a former HOTCI employee, alleged that the hospice provider submitted false claims to Medicare by seeking reimbursement for services given to patients who were ineligible for Medicare hospice care. With its main office in in Altamonte Springs, HOTCI provides hospice services in Seminole, Orange and Osceola counties in Florida.
From December 2005 to December 2010, HOTCI allegedly engaged in a Medicare fraud scheme to bill the federal healthcare program for hospice services to patients who were not terminal. According to the Department of Justice, HOTCI instructed its staff to admit any patient who was referred to the program, regardless of Medicare hospice eligibility. In addition, HOTCI staff allegedly were directed to falsify patient records so it would appear that patients actually did meet Medicare criteria when they did not. Further, HOTCI allegedly set up procedures to limit doctors’ roles in making an assessment of patients’ terminal status and put off discharging patients who became ineligible for Medicare benefits.
The HOTCI settlement also includes a Corporate Integrity Agreement to prevent and detect similar misconduct in the future. Robert Wilson, HOTCI’s former Chief Executive Officer, has also consented to a voluntary three-year exclusion from federal healthcare programs, including Medicare and Medicaid.
As a reward for collaborating with the government, the whistleblower will receive a share of the $3 million settlement, but the exact amount has not yet been determined.
Informants Blow the Whistle on Medicare Fraudsters
Health care workers are often caught on the front lines in the fight against Medicare fraud when they struggle to avoid participating in scams they know are wrong. These honest workers deserve a full explanation of their rights as provided in the False Claims Act before bringing suit. With experienced whistleblower lawyers in offices from coast to coast, Waters & Kraus knows how to watch out for your interests. When the time has come to collaborate with the government, contact us by email or call our False Claims Act lawyers at 855.784.0268 to learn more about our Medicare fraud practice.