A Medicare-certified hospice provider and its subsidiaries have agreed to pay $4.2 million to resolve allegations that they violated the False Claims Act. According to a May 1, 2024, Department of Justice press release, the company knowingly submitted false claims and retained overpayments for the care of hospice patients in Texas who were ineligible for the Medicare hospice benefit because they were not terminally ill.
The settlement resolves allegations that the company’s Texarkana, Texas, location knowingly submitted false claims for hospice services provided to patients who were ineligible for the hospice benefit because they were not terminally ill. The patients at issue in the settlement were at the Texarkana location between 2014 and 2019 and in 2020. The settlement also resolves allegations regarding two patients at other Texas locations between 2015 and 2021. The settlement further resolves allegations that the company knowingly and improperly concealed or avoided obligations to repay overpayments for these patients.
“Hospice care is intended to provide comfort and relief for the terminally ill and taking advantage of the system in order to make more money is intolerable,” said Deputy Inspector General for Investigations Christian J. Schrank of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “Working with our law enforcement partners, we will continue to pursue healthcare providers who jeopardize the integrity of hospice care by prioritizing illegitimate profit over medically necessary services.”
Compliance Perspective
Issue
All medical services that are provided must be medically necessary, and the patient or resident must be eligible for the services that are provided and involved in the decision to choose those services. Individuals receiving hospice services must meet specific criteria to be eligible for the program, including having less than six months to live. Providing medical services that are not necessary can be considered a false claim. Failure to promptly report a false claim can result in lawsuits, fines, and other sanctions.
Discussion Points
- Review policies and procedures related to hospice services to ensure they are accurate and current. Update policies as needed.
- Train staff on the criteria that must be met to enroll a resident into the hospice program. Additionally, train nursing staff and social services on the procedure to follow for receiving or making hospice referrals. Document that these trainings occurred and file each signed document in the employee’s education file.
- Periodically audit to ensure that residents enrolled in hospice programs meet eligibility criteria, and that documentation is sufficient to support the need for hospice services.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
