The Whistleblower Effect: How Qui Tam Actions Are Changing the Deterrence Calculus for Hospice Providers

Diakon Hospice, one of the oldest hospices in Pennsylvania, recently paid nearly $11 million to the Federal Government, related to submitting Medicare claims for beneficiaries who were not eligible for hospice benefits under the Medicare regulations. Diakon had voluntarily disclosed the problem to the Government. By voluntarily stepping forward, Diakon may have avoided a government lawsuit under the False Claims Act.

Hospice care, which offers emotional, physical, and spiritual care in addition to end-of-life palliative care to terminally ill patients, is covered under Medicare Part A, under very specific conditions. False Claims Act violations arise when hospices violate these conditions and purposefully submit ineligible claims for reimbursement. For example, a hospice provider potentially runs afoul of the FCA when it submits claims for services that are ineligible for reimbursement, misrepresents the conditions of patients, or misrepresents the purpose of hospice services to patients and their families in order to maintain their admission status for hospice care.

For more information about qui tam law and Medicare fraud, contact Nolan and Auerbach, P.A.