February 9, 2012
A settlement has been reached in three False Claims Act lawsuits filed against Odyssey HealthCare, a subsidiary of Gentiva Healthcare. Odyssey, which provides hospice services in approximately 27 states, will pay $25 million to settle the claims. The lawsuits alleged that Odyssey engaged in health care fraud regarding Medicare hospice benefits. Odyssey did not admit to the allegations against it.
Hospice benefits are available to patients with a terminal illness who choose palliative treatment. To be eligible, patients must have a diagnosed life expectancy of less than six months should the disease run its normal course. In most circumstances, hospice services are billed at a routine care level. But when the patient has an acute crisis and symptoms can only be treated at home with skilled nursing services, Medicare will also pay for continuous care. Not surprisingly, continuous care is vastly more expensive and the reimbursement rate is several hundred dollars per day more than the Medicare rate for routine care.
The False Claims Act suits alleged that from January 2006 to January 2009, Odyssey made false claims to Medicare for the more expensive continuous home care services when such care was unnecessary or was not given in compliance with Medicare requirements.
The whistleblowers in the Odyssey case were all former employees of the company, as is often the case in qui tam litigation, in which a private citizen who knows of fraud against the government brings suit under the False Claims Act on behalf of the United States. In this case, the whistleblowers will share payments in excess of $4.6 million.
Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Los Angeles, San Francisco, Dallas and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in health care fraud cases. Contact us to learn more about our practice and how we can assist.
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