Since 1983, Medicare has provided benefits for eligible terminally ill patients under The Medicare Hospice Benefit program, according to the National Hospice and Palliative Care Organization. The use of these services has increased in recent years, with Medicare reimbursements for hospice care exceeding $15 billion in 2015.
Palliative care under the program is intended only for patients who have six months or less to live. Services are tailored to the individual needs of each patient and are intended to allow terminally ill patients to maintain dignity. Pain management, reducing the impact of symptoms — as well as spiritual or emotional counseling — are the goals of the medical protocol, rather than efforts to prolong life.
Increased Scrutiny of Hospice Firms Related to Health Care Fraud
Unfortunately, with the rise in awareness of hospice care and the expansion of conditions that may qualify for government benefits, the potential for fraud also rises. The federal government has increased its scrutiny of hospice care programs and facilities, according to the Atlanta Journal-Constitution.
Two workers at a hospice facility came forward with evidence that between 2007 and 2011 the facility was unlawfully paying kickbacks to doctors for referrals. The whistleblowers brought a lawsuit to reclaim fraudulently obtained taxpayer money. The federal government later joined in the investigation and litigation. Recently, the hospice facility agreed to settle the lawsuit for $2.4 million.
Whistleblowers Help the Government Detect Fraud
Detecting Medicare fraud is always a complex and difficult process for federal officials. Often, evidence of health care fraud is brought forward by non-government individuals who are frequently referred to as whistleblowers. As this blog discussed last month, the False Claims Act allows individuals to file a whistleblower lawsuit on behalf of the government to recover taxpayer money that has been fraudulently obtained under a government contract or program. Whistleblowers are entitled to receive a percentage of any settlement or verdict that results from the lawsuit.
Starting a federal False Claims Act lawsuit may be daunting for workers in the health care industry. Similarly, many medical billing professionals, care givers or other health care professionals may not be familiar with the nuances of what may constitute Medicare fraud. Speaking with an attorney who has a strong command of the health care industry and the False Claims Act is an important first step in seeking justice for fraud.