January 6, 2015 — State and federal False Claims Act statutes exist in part to give health care insiders the means to bring a whistleblower lawsuit. The government relies on tipsters to protect the integrity of our Medicare and Medicaid healthcare programs. When medical providers cheat the system by overbilling Medicare for hospice care services that are unnecessary, they put the continued viability of hospice benefits at risk. Whistleblowers who file successful claims are entitled to a portion of the government’s recovery. Under the federal statute, the United States has the ability to intervene in the lawsuit and take over its prosecution. This is what’s happened in a recent Nevada case involving Medicare reimbursement for hospice care.
Las Vegas Hospice Providers Allegedly Overbilled Medicare for Unneeded and Nonexistent Hospice Services
Three affiliated Nevada providers of hospice care have been sued by the U.S. government in a False Claims Act lawsuit. Creekside Hospice II LLC, Skilled Healthcare LLC (SKH) and Skilled Healthcare Group Inc. (SKG) allegedly filed false claims with Medicare for hospice services the providers knew were ineligible. The government intervened in two consolidated whistleblower lawsuits filed by Joanne Cretney-Tsosie, a Creekside clinical manager, and Veneta Lepera, who previously worked for Creekside as a clinical manager. The two tipsters had filed suit under both the federal and the Nevada False Claims Acts.
The whistleblower lawsuits alleged that the Creekside providers instructed hospice staff to sign up hospice patients even when they were not terminally ill and were therefore ineligible for Medicare-reimbursed hospice benefits. At times, the providers directed staff to cover up the fraud by altering patient records after-the-fact to make it appear as though Medicare requirements had been satisfied. Creekside management also allegedly instructed that medical records be falsified to show that physicians had met with patients when no visits had taken place. Creekside management allegedly frowned upon the documentation of patients’ improvements, for fear that patients would be removed from hospice rolls and Medicare reimbursement for hospice benefits would be terminated. Creekside’s alleged misconduct reportedly resulted in the government’s overpayment of tens of millions of dollars for unnecessary or nonexistent hospice care.
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 provider of hospice services, contact us by email or call our qui tam attorneys at 855.784.0268 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.