Hospice Fraud - A report For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms

Health Insurance Claim Form 1500 Instructions - Hospice Fraud - A report For Employees, Whistleblowers, Attorneys, Lawyers and Law Firms

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Hospice fraud in South Carolina and the United States is an increasing problem as the amount of hospice patients has exploded over the past few years. From 2004 to 2008, the amount of patients receiving hospice care in the United States grew approximately 40% to nearly 1.5 million, and of the 2.5 million habitancy who died in 2008, nearly one million were hospice patients. The overwhelming majority of habitancy receiving hospice care receive federal benefits from the federal government through the Medicare or Medicaid programs. The condition care providers who contribute hospice services traditionally enroll in the Medicare and Medicaid programs in order to qualify to receive payments under these government programs for services rendered to Medicare and Medicaid eligible patients.

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Health Insurance Claim Form 1500 Instructions

While most hospice condition care organizations contribute thorough and ethical treatment for their hospice patients, because hospice eligibility under Medicare and Medicaid involves clinical judgments which may corollary in the payments of large sums of money from the federal government, there are enormous opportunities for fraudulent practices and false billing claims by unscrupulous hospice care providers. As new federal hospice fraud promulgation actions have demonstrated, the amount of condition care companies and individuals who are willing to try to defraud the Medicare and Medicaid hospice benefits programs is on the rise.

A new example of hospice fraud intriguing a South Carolina hospice is Southern Care, Inc., a hospice business that in 2009 paid .7 million to settle an Fca case. The defendant operated hospices in 14 other states, too, together with Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, to wit, were not terminally ill, lack of documentation of terminal illnesses, and that the business marketed to inherent patients with the promise of free medications, supplies, and the provision of home condition aides. Southern Care also entered into a 5-year Corporate Integrity business transaction with the Oig as part of the settlement. The qui tam relators received approximately million.

Understanding the Consequences of Hospice Fraud and Whistleblower Actions

U.S. And South Carolina consumers, together with hospice patients and their family members, and condition care employees who are employed in the hospice industry, as well as their Sc lawyers and attorneys, should wise up themselves with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and hospice fraud schemes that have industrialized across the country. Consumers need to protect themselves from unethical hospice providers, and hospice employees need to guard against knowingly or unwittingly participating in condition care fraud against the federal government because they may field themselves to executive sanctions, together with lengthy exclusions from working in an organization which receives federal funds, enormous civil monetary penalties and fines, and criminal sanctions, together with incarceration. When a hospice laborer discovers fraudulent guide intriguing Medicare or Medicaid billings or claims, the laborer should not partake in such behavior, and it is imperative that the unlawful guide be reported to law promulgation and/or regulatory authorities. Not only does reporting such fraudulent Medicare or Medicaid practices shield the hospice laborer from exposure to the foregoing administrative, civil and criminal sanctions, but hospice fraud whistleblowers may advantage financially under the recompense provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States.

Types of Hospice Care Services

Hospice care is a type of condition care service for patients who are terminally ill. Hospices also contribute withhold services for the families of terminally ill patients. This care includes bodily care and counseling. Hospice care is commonly in case,granted by a social department or private business popular ,favorite by Medicare and Medicaid. Hospice care is available for all age groups, together with children, adults, and the elderly who are in the final stages of life. The purpose of hospice is to contribute care for the terminally ill outpatient and his or her family and not to cure the terminal illness.

If a outpatient qualifies for hospice care, the outpatient can receive healing and withhold services, together with nursing care, healing social services, doctor services, counseling, homemaker services, and other types of services. The hospice outpatient will have a team of doctors, nurses, home condition aides, social workers, counselors and trained volunteers to help the outpatient and his or her family members cope with the symptoms and consequences of the terminal illness. While many hospice patients and their families can receive hospice care in the ease of their home, if the hospice patient's condition deteriorates, the outpatient can be transferred to a hospice facility, hospital, or nursing home to receive hospice care.

Hospice Care Statistics

The amount of days that a outpatient receives hospice care is often referenced as the "length of stay" or "length of service." The distance of service is dependent on a amount of distinct factors, together with but not itsybitsy to, the type and stage of the disease, the quality of and entrance to condition care providers before the hospice referral, and the timing of the hospice referral. In 2008, the midpoint distance of stay for hospice patients was about 21 days, the midpoint distance of stay was about 69 days, approximately 35% of hospice patients died or were discharged within 7 days of the hospice referral, and only about 12% of hospice patients survived longer than 180 days.

Most hospice care patients receive hospice care in private homes (40%). Other locations where hospice services are in case,granted are nursing homes (22%), residential facilities (6%), hospice outpatient facilities (21%), and acute care hospitals (10%). Hospice patients are generally the elderly, and hospice age group percentages are 34 years or less (1%), 35 - 64 years (16%), 65 - 74 years (16%), 75 - 84 years (29%), and over 85 years (38%). As for the terminal illness resulting in a hospice referral, cancer is the determination for approximately 40% of hospice patients, followed by debility unspecified (15%), heart disease (12%), dementia (11%), lung disease (8%), stroke (4%) and kidney disease (3%). Medicare pays the great majority of hospice care expenses (84%), followed by private guarnatee (8%), Medicaid (5%), charity care (1%) and self pay (1%).

As of 2008, there were approximately 4,700 locations which were providing hospice care in the United States, which represented about a 50% growth over ten years. There were about 3,700 companies and organizations which were providing hospice services in the United States. About half of the hospice care providers in the United States are for-profit organizations, and about half are non-profit organizations.
General overview of the Medicare and Medicaid Programs

In 1965, Congress established the Medicare schedule to contribute condition guarnatee for the elderly and disabled. Payments from the Medicare schedule arise from the Medicare Trust fund, which is funded by government contributions and through payroll deductions from American workers. The Centers for Medicare and Medicaid Services (Cms), previously known as the condition Care Financing management (Hcfa), is the federal department within the United States department of condition and Human Services (Hhs) that administers the Medicare schedule and works in partnership with state governments to administer Medicaid.

In 2007, Cms reorganized its ten geography-based field offices to a Consortia structure based on the agency's key lines of business: Medicare condition plans, Medicare financial management, Medicare fee for service operations, Medicaid and children's health, seek & certification and quality improvement. The Cms consortia consist of the following:

• Consortium for Medicare condition Plans Operations
• Consortium for Financial management and Fee for service Operations
• Consortium for Medicaid and Children's condition Operations
• Consortium for quality correction and seek & Certification Operations

Each consortium is led by a Consortium Administrator (Ca) who serves as the Cms's national focal point in the field for their business line. Each Ca is responsible for consistent implementation of Cms programs, policy and advice across all ten regions for matters pertaining to their business line. In increasing to accountability for a business line, each Ca also serves as the Agency's senior management legal for two or three Regional Offices (Ros), representing the Cms Administrator in external matters and overseeing executive operations.

Much of the daily management and doing of the Medicare schedule is managed through private guarnatee companies that compact with the Government. These private guarnatee companies, sometimes called "Medicare Carriers" or "Fiscal Intermediaries," are expensed with and responsible for accepting Medicare claims, determining coverage, and manufacture payments from the Medicare Trust Fund. These carriers, together with Palmetto Government Benefits Administrators (hereinafter "Pgba"), a department of Blue Cross and Blue Shield of South Carolina, operate pursuant to 42 U.S.C. §§ 1395h and 1395u and rely on the good faith and rigorous representations of condition care providers when processing claims.

Over the past forty years, the Medicare schedule has enabled the elderly and disabled to regain significant healing services from healing providers throughout the United States. significant to the success of the Medicare schedule is the fundamental view that condition care providers accurately and well submit claims and bills to the Medicare Trust Fund only for those healing treatments or services that are legitimate, cheap and medically necessary, in full compliance with all laws, regulations, rules, and conditions of participation, and, further, that healing providers not take advantage of their elderly and disabled patients.

The Medicaid schedule is available only to clear low-income individuals and families who must meet eligibility requirements set forth by federal and state law. Each state sets its own guidelines concerning eligibility and services. Although administered by personel states, the Medicaid schedule is funded primarily by the federal government. Medicaid does not pay money to patients; rather, it sends payments directly to the patient's condition care providers. Like Medicare, the Medicaid schedule depends on condition care providers to accurately and well submit claims and bills to schedule administrators only for those healing treatments or services that are legitimate, cheap and medically necessary, in full compliance with all laws, regulations, rules, and conditions of participation, and, further, that healing providers not take advantage of their indigent patients.

Medicare & Medicaid Hospice Laws Which sway Sc Hospices

Hospice fraud occurs when hospice organizations, by and through their employees, agents and owners, knowingly violate the terms and conditions of the applicable Medicare and Medicaid hospice statutes, regulations, rules and conditions of participation. In order to be able to identify hospice fraud, hospices, hospice patients, hospice employees and their attorneys and lawyers must know the Medicare laws and requirements relating to hospice care benefits.

Medicare's two main sources of authorization for hospice benefits are found in the social protection Act and the U.S. Code of Federal Regulations. The statutory provisions are primarily found at 42 U.S.C. §§ 1395d, 1395e, 1395f(a)(7), 1395x(d)(d), and 1395y, and the regulatory provisions are found at 42 C.F.R. Part 418.

To be eligible for Medicare benefits for hospice care, the outpatient must be eligible for Medicare Part A and be terminally ill. 42 C.F.R. § 418.20. terminal illness is established when "the personel has a healing determination that his or her life expectancy is 6 months or less if the illness runs its normal course." 42 C.F.R. § 418.3; 42 U.S.C. § 1395x(d)(d)(3). The patient's doctor and the healing director of the hospice must certify in writing that the outpatient is "terminally ill." 42 U.S.C. § 1395f(a)(7); 42 C.F.R. § 418.20. After a patient's preliminary certification, Medicare provides for two ninety-day advantage periods followed by an unlimited amount of sixty-day advantage periods. 42 U.S.C. § 1395d(a)(4). At the end of each ninety- or sixty-day period, the outpatient can be re-certified only if at that time he or she has less than six months to live if the illness runs its normal course. 42 U.S.C. § 1395f(a)(7)(A). The written certification and re-certifications must be maintained in the patient's healing records. 42 C.F.R. § 418.23. A written plan of care must be established for each outpatient setting forth the types of hospice care services the outpatient is scheduled to receive, 42 U.S.C. § 1395f(a)(7)(B), and the hospice care has to be in case,granted in accordance with such plan of care. 42 U.S.C. § 1395f(a)(7)(C); 42 C.F.R. § 418.56. Clinical records for each hospice outpatient must be maintained by the hospice, together with plan of care, assessments, clinical notes, signed observation of election, outpatient responses to medication and therapy, doctor certifications and re-certifications, outcome data, progress directives and doctor orders. 42 C.F.R. § 418.104.

The hospice must regain a written observation of election from the outpatient to elect to receive Medicare hospice benefits. 42 C.F.R. § 418.24. Importantly, once a outpatient has elected to receive hospice care benefits, the outpatient waives Medicare benefits for healing treatment for the terminal disease upon which is the admitting diagnosis. 42 C.F.R. § 418.24(d).

The hospice must prescribe an Interdisciplinary Group (Idg) or groups composed of individuals who work together to meet the physical, medical, psychosocial, emotional, and spiritual needs of the hospice patients and families facing terminal illness and bereavement. 42 C.F.R. § 418.56. The Idg members must contribute the care and services offered by the hospice, and the group, in its entirety, must supervise the care and services. A registered nurse that is a member of the Idg must be designated to contribute coordination of care and to ensure continuous evaluation of each patient's and family's needs and implementation of the interdisciplinary plan of care. The interdisciplinary group must include, but is not itsybitsy to, the following noteworthy and competent professionals: (i) A doctor of treatment or osteopathy (who is an laborer or under compact with the hospice); (ii) A registered nurse; (iii) A social worker; and, (iv) A pastoral or other counselor. 42 C.F.R. § 418.56.

The Medicare hospice regulations, at 42 C.F.R. § 418.200, summarize the requirements for hospice coverage in pertinent part as follows:

To be covered, hospice services must meet the following requirements. They must be cheap and significant for the palliation and management of the terminal illness as well as connected conditions. The personel must elect hospice care in accordance with §418.24. A plan of care must be established and periodically reviewed by the attending physician, the healing director, and the interdisciplinary group of the hospice schedule as set forth in §418.56. That plan of care must be established before hospice care is provided. The services in case,granted must be consistent with the plan of care. A certification that the personel is terminally ill must be completed as set forth in section §418.22.

The social protection Act, at 42 U.S.C. § 1395y(a), limits Medicare hospice benefits, providing in pertinent part as follows: "Notwithstanding any other provision of this title, no cost may be made under part A or part B for any expenses incurred for items or services-... (C) in the case of hospice care, which are not cheap and significant for the palliation or management of terminal illness...." 42 C.F.R. § 418.50 (hospice care must be "reasonable and significant for the palliation and management of terminal illness"). Palliative care is defined in the regulations as "patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate outpatient autonomy, entrance to information, and choice." 42 C.F.R. § 418.3.

Medicare pays hospice agencies a daily rate for each day a beneficiary is enrolled in the hospice advantage and receives hospice care. The daily payments are made regardless of the amount of services furnished on a given day and are intended to cover costs that the hospice incurs in furnishing services identified in the patient's plan of care. There are four levels of payments which are made based on the amount of care required to meet beneficiary and family needs. 42 C.F.R. § 418.302; Cms Hospice Fact Sheet, November 2009. These four levels, and the corresponding 2010 daily rates, are as follows: habit home care (2.91); continuous home care (4.10); outpatient respite care (7.83); and, normal outpatient care (5.74).

The blend yearly cap per outpatient in 2009 was ,014.50. This cap is carefully by adjusting the former hospice outpatient cap of ,500, set in 1984, by the consumer Price Index. See Cms Internet-Only by hand 100-04, part 11, section 80.2; 42 U.S.C. § 1395f(i); 42 C.F.R. § 418.309. The Medicare Claims Processing Manual, at part 11 - Processing Hospice Claims, in Section 80.2, entitled "Cap on unabridged Hospice Reimbursement," provides in pertinent part as follows: "Any payments in excess of the cap must be refunded by the hospice."

Hospice patients are responsible for Medicare co-insurance payments for drugs and respite care, and the hospice may payment the outpatient for these co-insurance payments. However, the co-insurance payments for drugs are itsybitsy to the lesser of or 5% of the cost of the drugs to the hospice, and the co-insurance payments for respite care are generally 5% of the cost made by Medicare for such services. 42 C.F.R. § 418.400.

The Medicare and Medicaid programs want institutional condition care providers, together with hospice organizations, to file an enrollment application in order to qualify to receive the programs' benefits. As part of these enrollment applications, the hospice providers certify that they will comply with Medicare and Medicaid laws, regulations, and schedule instructions, and additional certify that they understand that cost of a claim by Medicare and Medicaid is conditioned upon the claim and fundamental transaction complying with such schedule laws and requirements. The Medicare Enrollment Application which hospice providers must execute, Form Cms-855A, states in part as follows: "I agree to abide by the Medicare laws, regulations and schedule instructions that apply to this provider. The Medicare laws, regulations, and schedule instructions are available through the Medicare contractor. I understand that cost of a claim by Medicare is conditioned upon the claim and the fundamental transaction complying with such laws, regulations, and schedule instructions (including, but not itsybitsy to, the Federal Aks and Stark laws), and on the provider's compliance with all applicable conditions of participation in Medicare."

Hospices are generally required to bill Medicare on a monthly basis. See the Medicare Claims Processing Manual, at part 11 - Processing Hospice Claims, in Section 90 - Frequency of Billing. Hospices generally file their hospice Medicare claims with their Fiscal Intermediary or Medicare Carrier pursuant to the Cms Claims by hand Form Cms 1450 (sometime also called a Form Ub-04 or Form Ub-92), either in paper or electronic form. These claim forms contain representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of significant facts may serve as the basis for civil monetary penalties and criminal convictions; (2) submission of the claim constitutes certification that the billing facts is true, strict and complete; (3) the submitter did not knowingly or recklessly disregard or misrepresent or conceal material facts; (4) all required doctor certifications and re-certifications are on file; (5) all required outpatient signatures are on file; and, (6) for Medicaid purposes, the submitter understands that because cost and satisfaction of this claim will be from Federal and State funds, any false statements, documents, or concealment of a material fact are field to prosecution under applicable Federal or State Laws.

Hospices must also file with Cms an yearly cost and data report of Medicare payments received. 42 U.S.C. § 1395f(i)(3); 42 U.S.C. § 1395x(d)(d)(4). The yearly hospice cost and data reports, Form Cms 1984-99, contain representations and certifications which state in pertinent part that: (1) misrepresentations or falsifications of facts contained in the cost report may be punishable by criminal, civil and executive actions, together with fines and/or imprisonment; (2) if any services identified in the report were the stock of a direct or indirect kickback or were otherwise illegal, then criminal, civil and executive actions may result, together with fines and/or imprisonment; (3) the report is a true, strict and complete statement prepared from the books and records of the supplier in accordance with applicable instructions, except as noted; and, (4) the signing officer is customary with the laws and regulations concerning the provision of condition care services and that the services identified in this cost report were in case,granted in compliance with such laws and regulations.

Hospice Anti-Fraud promulgation Statutes

There are a amount of federal criminal, civil and executive promulgation provisions set forth in the Medicare statutes which are aimed at preventing fraudulent conduct, together with hospice fraud, and which help voice schedule integrity and compliance. Some of the more leading promulgation provisions of the Medicare statutes contain the following: 42 U.S.C. § 1320a-7b (Criminal fraud and anti-kickback penalties); 42 U.S.C. § 1320a-7a and 42 U.S.C. § 1320a-8 (Civil monetary penalties for fraud); 42 U.S.C. § 1320a-7 (Administrative exclusions from participation in Medicare/Medicaid programs for fraud); 42 U.S.C. § 1320a-4 (Administrative subpoena power for the Comptroller General).

Other criminal promulgation provisions which are used to combat Medicare and Medicaid fraud, together with hospice fraud, contain the following: 18 U.S.C. § 1347 (General condition care fraud criminal statute); 21 U.S.C. §§ 353, 333 (Prescription Drug Marketing Act); 18 U.S.C. § 669 (Theft or Embezzlement in relationship with condition Care); 18 U.S.C. § 1035 (False statements relating to condition Care); 18 U.S.C. § 2 (Aiding and Abetting); 18 U.S.C. § 3 (Accessory after the Fact); 18 U.S.C. § 4 (Misprision of a Felony); 18 U.S.C. § 286 (Conspiracy to defraud the Government with respect to Claims); 18 U.S.C. § 287 (False, Fictitious or Fraudulent Claims); 18 U.S.C. § 371 (Criminal Conspiracy); 18 U.S.C. § 1001 (False Statements); 18 U.S.C. § 1341 (Mail Fraud); 18 U.S.C. § 1343 (Wire Fraud); 18 U.S.C. § 1956 (Money Laundering); 18 U.S.C. § 1957 (Money Laundering); and, 18 U.S.C. § 1964 (Racketeer Influenced and Corrupt Organizations ("Rico")).

The False Claims Act (Fca)

Hospice fraud whistleblowers may advantage financially under the recompense provisions of the federal False Claims Act, 31 U.S.C. §§ 3729-3732, by bringing false claims suits, also known as qui tam or whistleblower suits, against their employers on behalf of the United States. The plaintiff in a hospice fraud whistleblower suit is also known as a relator. The most common Fca provisions upon which hospice fraud qui tam or whistleblower relators rely are found in 31 U.S.C. § 3729: (A) knowingly presents, or causes to be presented, a false or fraudulent claim for cost or approval; (B) knowingly makes, uses, or causes to be made or used, a false report or statement material to a false or fraudulent claim; (C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);..., and, (G) knowingly makes, uses, or causes to be made or used, a false report or statement material to an promulgation to pay or send money or asset to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an promulgation to pay or send money or asset to the Government.... There is no requirement to prove specific intent to defraud. Rather, it is only significant to prove actual knowledge of the false claims, false statements, or false records, or the defendant's deliberate indifference or reckless disregard of the truth or falsity of the information. 31 U.S.C. § 3729(b).

The Fca anti-retaliation provision protects the hospice whistleblower from retaliation from the hospice when the laborer (or a contractor) "is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against in the terms and conditions of employment" for taking operation to try to stop the fraudulent activity. 31 U.S.C. § 3730(h). A hospice employee's relief includes reinstatement, 2 times the amount of back pay, interest on the back pay, and recompense for any extra damages sustained as a corollary of the discrimination or retaliation, together with litigation costs and cheap attorneys' fees.

A Sc hospice fraud Fca whistleblower would initially file a disclosure statement, complaint and supporting documents with the U.S. Attorney's Office in Columbia, South Carolina, and the Us Attorney General. After the disclosures are filed, a federal court complaint can be filed. The Sc department where the frauds occurred, the relator's residence, and the defendant residence, will settle which department the case will be assigned. There are eleven federal court divisions in South Carolina. Once the case has been filed, the government has 60 days to settle either or not to intervene. While this time, federal government investigators located in South Carolina will explore the claims. If the case involved Medicaid, Sc Medicaid fraud unit investigators will likely become involved as well. If the government intervenes in the case, the U.S. Attorney for South Carolina is commonly the lead attorney. If the government does not intervene, the relator's Sc attorney will prosecute the case. In South Carolina, expect a qui tam case to take one to two years to get to trial.

Tips on Recognizing Hospice Fraud Schemes

The Hhs Office of Inspector normal (Oig) has issued extra Fraud Alerts for fraudulent and abusive practices of hospices. U.S. And South Carolina hospices, patients, hospice employees and whistleblowers, their attorneys and lawyers, should be customary with these hospice fraud practices. Tips on recognizing hospice frauds in South Carolina and the U.S. Are:

• A hospice contribution free goods or goods at below market value to induce a nursing home to refer patients to the hospice.
• False representations in a hospice's Medicare/Medicaid enrollment form.
• A hospice paying "room and board" payments to the nursing home in amounts in excess of what the nursing home would have received directly from Medicaid had the outpatient not been enrolled in the hospice.
• False statements in a hospice's claim form (Cms Forms 1450, Ub-04 or Ub-92).
• A hospice falsely billing for services that were not cheap or significant for the palliation of the symptoms of a terminally ill patient.
• A hospice paying amounts to the nursing home for "additional" services that Medicaid carefully included in its room and board cost to the hospice.
• A hospice paying above fair market value for "additional" non-core services which Medicaid does not think to be included in its room and board payments to the nursing home.
• A hospice referring patients to a nursing home to induce the nursing home to refer its patients to the hospice.
•A hospice providing free (or below fair market value) care to nursing home patients, for whom the nursing home is receiving Medicare cost under the skilled nursing installation benefit, with the anticipation that after the outpatient exhausts the skilled nursing installation benefit, the outpatient will receive hospice services from that hospice.
• A hospice providing staff at its price to the nursing home to achieve duties that otherwise would be performed by the nursing home.
• Incomplete or no written Plan of Care was established or reviewed at specific intervals.
• Plan of Care did not contain an evaluation of needs.
• Fraudulent statements in a hospice's cost report to the government.
• observation of election was not obtained or was fraudulently obtained.
• Rn supervisory visits were not made for home condition aide services.
• Certification or Re-certification of terminal illness was not obtained or was fraudulently obtained.
• No Plan of care was included for bereavement services.
• Fraudulent billing for upcoded levels of hospice care.
• Hospice did not guide a self-assessment of quality and care provided.
• Clinical records were not maintained for every patient.
• Interdisciplinary group did not spin and modernize the plan of care for each patient.

Recent Hospice Fraud promulgation Cases

The Doj and U.S. Attorney's Offices have been active in enforcing hospice fraud cases.

In 2009, Kaiser Foundation Hospitals located an Fca lawsuit by paying .8 million to the federal government. The defendant assertedly failed to regain written certifications of terminal illness for a amount of its patients.

In 2006, Odyssey Healthcare, a national hospice provider, paid .9 million to settle a qui tam suit for false claims under the Fca. The hospice fraud allegations were generally that Odyssey billed Medicare for providing hospice care to patients when they were not terminally ill and ineligible for Medicare hospice benefits. A Corporate Integrity business transaction was also a part of the settlement. The hospice fraud qui tam relator received .3 million for blowing the whistle on the defendant.

In 2005, Faith Hospice, Inc., located claims an Fca claim for 0,000. The hospice fraud allegations were generally that Faith Hospice billed Medicare for providing hospice care to patients more than half of whom were not terminally ill.

In 2005, Home Hospice of North Texas located an Fca claim for 0,000 concerning allegations of fraudulently billing Medicare for ineligible hospice patients.

In 2000, Michigan osteopath Donald Dreyfuss, who pleaded guilty to criminal fraud charges, together with violation of the Aks for receiving illegal kickbacks from a hospice for recommending the hospice to the staff of his nursing home, located an Fca suit for million.

Conclusion

Hospice fraud is a growing problem in South Carolina and throughout the United States. South Carolina hospice patients, hospice employees, and their Sc lawyers and attorneys, should be customary with the basics of the hospice care industry, hospice eligibility under the Medicare and Medicaid programs, and typical hospice fraud schemes. Hospice organizations should take steps to ensure full compliance with Medicare/Medicaid hospice billing requirements to avoid hospice fraud allegations and Fca litigation.

© 2010 Joseph P. Griffith, Jr.

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