Medicare typically only pays for hospice care when patients are in a terminal condition and are expected to live for less than six months. Given this principle, something is likely amiss when a substantial percentage of a hospice provider’s patients are clocking lengths of stays in excess of three years. Indeed, based on recently concluded False Claims Act cases, the 1,000-day mark seems to raise the ire of the Justice Department.
For example, in November 2015, Florida-based Hospice of Citrus County paid the government $3 million to settle a False Claims Act action, alleging that it knowingly submitting false claims to government healthcare programs for medically unnecessary hospice care of certain patients who had lengths of stays greater than 1,000 days. The government alleged that the hospice provider inappropriately treated 52 patients for lengths of stays in excess of 3 years.
Upon examining the medical records for these 52 patients, the government alleged that the hospice provider knowingly or recklessly failed to document a valid basis for the initial start of hospice care and/or subsequent hospice coverage. According to the government, the failure in documentation included no support for the length of hospice services; patient files that failed to document basic patient characteristics; and patient records that were either unsigned or signed with inconsistent practitioner information.
This was a rare False Claims Acts recovery in which a whistleblower did not play a role in uncovering the hospice fraud. Instead, the number of patients exceeding the 1,000 length-of-stay mark may have invited additional scrutiny from the government.
More information for whistleblowers is located at the Nolan Auerbach & White website.