March 4, 2015 — The federal False Claims Act empowers hospice insiders to file a whistleblower lawsuit on behalf of the United States. When hospice providers cheat the system by overbilling Medicare for hospice care services that are unnecessary or ineligible for reimbursement, they put the continued viability of hospice benefits at risk. Whistleblowers, who are also referred to as “relators,” are entitled to a portion of the government’s recovery. Under the Act, the United States has the ability to intervene in the lawsuit and assume primary control for litigating it. The statute provides for a recovery equivalent to three times the actual damages plus civil penalties.
Hospice Provider Allegedly Billed Medicare for Treatment of Patients Who Were Not Terminally Ill
A for-profit hospice group based in Oklahoma City has agreed to settle a False Claims Act lawsuit for $4 million. Good Shepherd Hospice Inc., Good Shepherd Hospice of Mid America Inc., Good Shepherd Hospice – Dallas L.L.C., Good Shepherd Hospice, Springfield, L.L.C. and Good Shepherd Hospice, Wichita, L.L.C. (collectively Good Shepherd) allegedly filed false claims with Medicare for hospice patients whose illnesses were not terminal.
The government discovered the alleged misconduct when two former Good Shepherd employees, Kathi Cordingley and Tracy Jones, filed a qui tam lawsuit under the False Claims Act. The two whistleblowers will receive $680,000 as their share of the government’s recovery.
The rules governing Medicare hospice benefits are strictly enforced. Patients are eligible only when their life expectancy is less than six months. Hospice benefits are restricted to palliative treatment which focuses on making patients physically and mentally comfortable. Medicare patients who opt to receive hospice services forfeit the right to Medicare coverage for care designed to be curative.
Good Shepherd reportedly neglected to give its staff proper training on hospice eligibility criteria and then pressured them to reach arbitrary admissions goals. The provider paid bonuses to executive directors, hospice marketers and admissions nurses who met their admissions targets. In addition, the company retained medical directors based on the strength of their contacts with nursing homes, which were viewed as likely sources for patient referrals.
False Claims Act Lawsuits Target Abuse by Hospice Providers
While Waters & Kraus is not handling this particular False Claims Act case, we are representing whistleblowers in similar lawsuits. If you have comparable claims against a different hospice provider, contact us by email or call our qui tam attorneys at 800.226.9880 to learn more about our practice and how we can work together to notify the government about fraudulent abuses of government-funded programs. George Tankard and Anne Izzo, qui tam lawyers in Waters & Kraus’ Maryland office, protect tipsters throughout the whistleblower lawsuit process.