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Whistleblower defeats Medicare fraud (part 2)

This continues our discussion from last week about Odyssey Healthcare's $25,000,000 payment to settle whistleblower claims brought by our client, DR. Odyssey (now purchased by Gentiva) was one of the largest hospice care providers in the country and derived approximately 95% of its net patient revenue from payments it received from Medicare. The Medicare hospice benefit is designed to provide care to terminally ill patients. Hospice nursing care may be covered by Medicare for up to 24 hours-a-day as continuous care during "periods of crisis." However, when fewer than eight hours of care was needed in a 24 hour period, Odyssey was supposed to bill for routine care rather than continuous home care.

By reviewing of patient records and speaking to nurses whom she supervised, DR discovered that Odyssey was defrauding Medicare by diverting patients into Continuous Care even though the conditions of those patients were not adequately severe to qualify for the Medicare benefit. DR also became aware of a prevalent practice in which Odyssey "double booked" or charged Medicare for Continuous Care for one patient while the nurse assigned to that patient simultaneously was assigned to provide care to one or more other hospice patients.

DR reported the ongoing Continuous Care misclassification of Hospice patients to Odyssey's management. Following this report, Odyssey conducted a brief investigation but failed to interview most of the nurses overseen by DR who had direct contact with patients. Odyssey management deliberately instructed those nurses to stop communicating with DR. When the fraud did not stop, DR was forced to leave her job.

In future posts, I will address the litigation process in this whistleblower case and its ultimate settlement.

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Alan Olson writes this web-log to provide helpful information regarding employment law cases. He practices employment law throughout the United States from his offices in New Berlin, Wisconsin. Attorney Olson may be contacted at [email protected] with questions about the information posted here or for advice on whistleblower claims.

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