The Medicare hospice benefit is available for patients who elect palliative treatment (medical care focused on providing patients with relief from pain, symptoms or stress) for a terminal illness and have a life expectancy of six months or less, if their illness runs its normal course. When a Medicare patient receives hospice services, that individual is no longer entitled to Medicare coverage for care designed to cure his or her illness.
In February 2015, Good Shepherd Hospice Inc., Good Shepherd Hospice of Mid America Inc., Good Shepherd Hospice, Wichita LLC, Good Shepherd Hospice, Springfield LLC, and Good Shepherd Hospice – Dallas LLC (collectively “Good Shepherd”) agreed to pay $4 million to resolve allegations that it submitted false claims for hospice patients who were not terminally ill. Each Good Shepherd entity has agreed to have continued monitoring by the Department of Health and Human Services as part of their Corporate Integrity Agreement. Good Shepherd is a for-profit hospice headquartered in Oklahoma City, which provides hospices services in Oklahoma, Missouri, Kansas and Texas.
The government alleged that Good Shepherd knowingly submitted or caused the submission of false claims for hospice care for patients who were not terminally ill. Specifically, the United States contended that Good Shepherd engaged in certain business practices that contributed to claims being submitted for patients who did not have a terminal diagnosis of six months or less, by pressuring staff to meet admissions and census targets and paying bonuses to staff, including hospice marketers, admissions nurses and executive directors, based on the number of patients enrolled. The United States further alleged that Good Shepherd hired medical directors based on their ability to refer patients focusing particularly on medical directors with ties to nursing homes, which were seen as an easy source of patient referrals. The United States also alleged that Good Shepherd failed to properly train staff on the hospice eligibility criteria.
“The Medicare hospice benefit is intended to provide comfort and care to patients nearing the end of life,” said Acting Assistant Attorney General Joyce R. Branda of the Justice Department’s Civil Division. “We will continue to aggressively pursue companies that abuse the hospice benefit to improperly inflate their profits.”
The Corporate Integrity Agreement appears to be similar to one put in place after Nolan Auerbach & White’s successful $25 million qui tam whistleblower case against hospice chain Odyssey Healthcare (subsidiary of Gentiva), wherein the covered entities are required to submit claims to annual independent claims reviews for the next five years. In effect, somebody will be looking over their shoulders, scanning for instances of inappropriate billing. Perhaps this added CIA burden will discourage other hospices from embracing similar practices.
More information for whistleblowers is located at the Nolan Auerbach & White website.