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Federal Prosecutions for Hospice-Related Healthcare Fraud Are on the Rise

Categories: Health Care Fraud

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Dr. Nick Oberheiden, Esq.
www.federal-lawyer.com
1-800-810-0259
Including Weekends

In recent years, the Department of Justice (DOJ), in conjunction with the Department of Health and Human Services (DHHS), has increasingly focused its attention on investigating and prosecuting hospice owners and employees who are suspected of healthcare fraud. Federal prosecutors across the nation have stated on the record that they are aggressively pursuing hospice providers who engage in misconduct regarding patient care and billing practices.

What Is Hospice Fraud?

Hospice-related healthcare fraud typically involves billing healthcare providers for unnecessary or unprovided medical services, inflating bills through exaggerated billing codes, or improperly certifying patients as eligible for hospice care. In order to be eligible for hospice care, the patient’s primary care physician must certify that the patient has a terminal illness and is expected to die within six months. Hospice providers have gotten into trouble for paying kickbacks to physicians for patient referrals or billing healthcare companies for providing hospice services to patients they know to be unqualified for hospice care.

What Are the Penalties for Hospice Fraud?

Hospice providers accused of healthcare fraud may be charged civilly, criminally or both. Civil charges usually arise under the federal False Claims Act, wherein hospice providers are held accountable for presenting unjustified bills to Medicare or any other government-run healthcare providers. Penalties for those convicted of civil charges include fines, restitution, and administrative regulation. Criminal charges, on the other hand, often stem from alleged violations of federal healthcare statutes, and, if convicted, a hospice provider will face up to ten years in federal prison for each count of fraud, among other penalties. A growing trend among federal prosecutors is to pursue both civil and criminal charges against hospice providers suspected of healthcare fraud.

Examples of Hospice Fraud Cases

Below are just a few examples of the hospice-related healthcare fraud prosecutions that have occurred throughout the country in the past year:

  • In March 2016, five Michigan defendants, including three hospice owners and two referring physicians, pled guilty to participating in a multimillion-dollar healthcare fraud scheme. The three hospice owners admitted to paying kickbacks to physicians for patient referrals and billing Medicare for unnecessary or unprovided medical services, whereas the two physicians admitted to receiving kickbacks and falsifying patient records to perpetuate the fraud. https://www.justice.gov/opa/pr/last-five-defendants-pleads-guilty-multimillion-dollar-medicare-fraud-scheme-involving
  • In February 2016, a Pennsylvania hospice nurse was convicted of four counts of healthcare fraud for knowingly admitting ineligible patients into hospice care and billing Medicare for hospice services that were never provided to patients. The jury found that the nurse was responsible for the submission of millions of dollars’ worth of fraudulent claims to Medicare. https://www.justice.gov/opa/pr/nurse-convicted-role-multimillion-dollar-hospice-health-care-fraud
  • An investigation into an Illinois hospice agency has led to guilty convictions against six individuals and the hospice itself for Medicare and Medicaid fraud in early 2016. The individuals, including two co-owners and four administrators of the hospice, are accused of intentionally inflating patients’ bills to reflect a higher level of service that the patients actually received. https://www.justice.gov/usao-ndil/pr/director-lisle-based-hospice-company-convicted-scheme-fraudulently-bill-medicare-0
  • An Iowa hospice agency spent $1,088,244.02 in December 2015 to settle a claims that it violated the False Claims Act by billing Medicare for hospice services that were provided to patients who were not qualified to receive hospice care. https://www.justice.gov/usao-ndia/pr/iowa-hospice-pay-more-1-million-resolve-false-claims-act-allegations
  • In December 2015, a Mississippi hospice owner was sentenced to three years in federal prison, followed by three years’ probation, in addition to being ordered to pay $1,098,639 in restitution after pleading guilty to violations of the federal Health Care Fraud statute. The hospice owner admitted to actively soliciting patients who were not eligible for hospice care and billing Medicare millions of dollars for hospice services provided to the unqualified patients. https://www.justice.gov/usao-ndms/pr/cleveland-woman-sentenced-hospice-fraud
  • The owner/operator of 13 hospice agencies located throughout Mississippi, Louisiana, Texas, and Alabama, as well as the agencies themselves, agreed in September 2015 to pay $5,867,518 in order to settle charges that the hospice agencies violated the False Claims Act by billing Medicare for providing a higher level of hospice treatment than their patients’ conditions warranted. https://www.justice.gov/usao-sdms/pr/hospice-facility-and-its-managermajority-owner-pay-approximately-586-million-resolve
  • An Oklahoma hospice owner was sentenced in July 2015 to three years in federal prison, an additional three years on probation, and $2,519,813.33 in restitution payments after being found guilty of healthcare fraud and other related charges. The hospice owner was accused of providing hospice services to ineligible patients as well as falsifying medical documents in order to pass a Medicare audit. https://www.justice.gov/usao-wdok/pr/hospice-company-owner-sentenced-serve-three-years-prison-and-pay-over-25-million

Success Stories

The attorneys of Oberheiden & McMurrey, LLP have profound experience when it comes to home health, hospice fraud, and healthcare fraud investigations. Here are some representative healthcare investigations that we handled on behalf of individual and corporate clients.

  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.
  • Healthcare Fraud Investigation
    Result: No liability, case dismissed.

Free Consultation

If you have been contacted by law enforcement regarding your hospice care practice, you should immediately consult an experienced lawyer to limit your exposure to civil or criminal penalties. Such contact may be in the form of a payment stop, an interview requests, or a subpoena. The experienced attorneys at Oberheiden & McMurrey, LLP are standing by 24 hours a day, seven days a week for a free and confidential consultation regarding your matter.

Oberheiden & McMurrey, LLP
Criminal Defense – Healthcare Law – Litigation
(800) 810-0259
(214) 469-9009
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
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