Healthcare providers and businesses in the industry that put their own bottom lines ahead of the needs of patients can cost taxpayers large amounts of money. Billing policies and quotas to increase company revenues are occasionally suspect practices that may indicate that healthcare fraud exists.
A recent whistleblower lawsuit filed under the Federal False Claims Act alleged that a hospice care provider sought to increase its revenues by certifying patients as terminally ill, even though their medical records did not support the medical conclusion.
Lawsuit Says Ineligible Patients Were Provided Hospice Care
The government says that the hospice chain had aggressive census targets and patients who were ineligible for hospice care were admitted to satisfy corporate goals, not for medical necessity. Internal audits were conducted where many medical professionals in the organization noted that patients were being admitted to the program who were ineligible for the hospice services. The company allegedly ignored the internal communications and continued to bill the Medicare for hospice benefits.
The hospice chain also did not take any steps to investigate past billing practice to determine if prior hospice benefit reimbursements are valid, according to the Department of Justice. The government says that the company had a duty to investigate its past billing practices to determine if overbilling had occurred.
A registered nurse for the care company came forward with evidence of the fraud. She filed a “qui tam” lawsuit on behalf of the government. The FCA allows ordinary people—people not in service to the government – to file lawsuits to seek recovery of taxpayer money that is fraudulently obtained related to a government contract or healthcare program. Whistleblowers receive a percentage of any settlement or verdict obtained in the lawsuit.
The company does not admit fault in settling the lawsuit. It is not clear from the DOJ notice how much money was fraudulently obtained. The hospice provider settled the lawsuit for $8.5 million. The whistleblower is expected to receive slightly more than $1.4 million for bringing the lawsuit forward.