Hospice Care is the Newest Frontier in Medicare Fraud and Whistleblower Claims Under the False Claims Act
The demand for hospice care is exploding. Because most of the recipients of end-of-life care are elderly, the taxpayer funded Medicare program often must foot the bill. It comes as no surprise then that federal Medicare expenditures for hospice care have doubled in recent years.
Medicare’s hospice care program is only designed to be used during a patient’s last 6 months of life. Some folks, however, are in hospice care for years. An article in today’s Wall Street Journal says that between 2005 and 2013, 107,000 people received hospice care for an average of 1000 days. Those patients accounted for just 1.3% of the total number of hospice care patients but more than 10 times that number in spending.
Why are so many people in hospice care for so long? The answers may surprise you.
Medically, the primary reason is the rise of dementia patients needing end-of-life care. Better medical treatment keeps folks alive longer. Dementia patients rarely recover, however, meaning they have continuous care needs.
There is a more sinister back story, however.
Hospice care providers are bilking the Medicare system and therefore taxpayers. Obviously, most hospice care workers are honest, hard working people. They are angels and I am sure my late mother was comforted greatly in her last days by her wonderful caregivers.
The caregivers may be wonderful but like every industry, there are bad apples. For example, just last week an Illinois hospice administrator, Gwen Hilsabeck, pleaded guilty in a $9.5 hospice based Medicare fraud. She isn’t alone.
Hospice companies are now trolling nursing homes looking to enroll patients in a hospice program. A medical necessity determination is required but patient families often pressure doctors into making such determinations.
Why? Because the benefits available under hospice care are quite generous. Families that struggle with how to care for loved ones’ long term care needs find hospice programs offer more. They also cost more and those Medicare expenses are passed on to taxpayers.
According to the Journal, hospice spending nearly doubled over the last nine years. We are not surprised.
Hospice Care and the False Claims Act
The federal False Claims Act is a Civil War era statute used to combat fraud, it empowers ordinary people to file claims on behalf of the United States. (Many states have similar laws for state funded Medicaid programs.)
To be eligible to file, one must have inside knowledge regarding fraud involving federal funds or programs. Because Medicare is funded with tax dollars, it qualifies.
Whistleblowers who bring a False Claims Act case are entitled to a percentage of whatever monies are ultimately recovered by the government. In October of last year, an Alabama jury found AseraCare liable for bilking an estimated $67.5 million from Medicare. That translates into a minimum $10,125,000 whistleblower award. (The judge subsequently granted a new trial after determining she provided poor jury instructions. The Justice Department is seeking upwards of $200 million from AseraCare. How the final chapter plays out is unknown but hospice care billing fraud remains a huge problem.)
If you have inside knowledge of fraud involving hospice care, give us a call. Our False Claims Act whistleblower clients have collected over $100 million in awards. Real money for real heroes.
We can evaluate your information, discuss how the process works, and if you file, help insure you get the maximum award possible.
For more information, contact attorney Brian Mahany at brian@mahanylaw.com or by telephone at (414) 704-6731 (direct). All inquiries are protected by the attorney-client privilege and kept confidential.
MahanyLaw – America’s Whistleblower Lawyers
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