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What is Hospice Care Fraud?

Categories: Health Care Law

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Dr. Nick Oberheiden, Esq.
www.federal-lawyer.com
Direct: (214) 469-9009
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Recent newspaper articles have begun to feature hospice care prosecutions. According to these press releases and media publications, a rapidly increasing number of hospice care providers and business owners have become targets of federal healthcare fraud prosecutions. The purpose of this article is to take a look at hospice care fraud allegations, written from the unique perspective of former senior government officials and experienced healthcare fraud defense attorneys.

Hospice Fraud Explained

Government authorities have dramatically expanded criminal investigations in connection with hospice care in recent months. Because a great number of Medicare beneficiaries die while in hospice, the government has increased its efforts to monitor federal expenses for high-dollar hospice care entities. While fraud in the context of hospice care is typically investigated and charged as general healthcare fraud pursuant to 18 U.S.C. Sect. 1347, the two most often quoted bases for investigating hospice fraud can be summarized as follows:

  • Certification Errors. Similar to related home healthcare fraud, the government claims that many hospice patients in fact do not qualify for expensive hospice care and allege that doctors, nurses, and business owners conspire to certify hospice needs to financially benefit from Medicare reimbursements. In cases that we were involved in, the government accused individuals of fabricating, manipulating, and falsifying hospice certification and attempted to charge physicians, nurses, and business owners for anti-kickback violations, criminal false claims act offenses, and federal healthcare fraud.
  • Unnecessary Services. In addition, the federal government often claims that clinical services provided or medications ordered on behalf of hospice patients are medically unnecessary and thus constitute fraud and abuse to the detriment of the United States.

What Are the Penalties?

Hospice fraud is investigated by the Office of Inspector General (OIG), the Department for Health and Human Services (HHS), the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), Medicaid Fraud Control Units (MFCUs), and state Medicaid agencies in cooperation with the Health Care Fraud Prevention and Enforcement Action Team (HEAT), the General Services Administration (GSA), and the Centers for Medicare and Medicaid Services (CMS).

If found liable, targets of hospice fraud may be exposed to recoupment requests, non-payment of future claims, civil fines of up to $ 11,000 per false claim, exclusion from federal healthcare programs, treble damages, attorney’s fees, criminal fines, and incarceration in a federal prison.

Notably, criminal liability does not require a specific intent to violate the law; in fact, the government does not even need to prove actual knowledge of the wrongfulness of the transaction.

Defending Hospice Fraud

Oberheiden & McMurrey, LLP is a boutique healthcare fraud defense firm with headquarters in Dallas, Texas. Clients from Texas and beyond seek our services to defend allegations of improper billing, medically unnecessary services, false certifications, and other components of healthcare fraud.

What makes us unique is the composition of our team and our long and distinct track record of dismissed healthcare fraud cases. When you hire the attorneys of Oberheiden & McMurrey, LLP, you will not just be represented by experienced healthcare fraud attorneys, but also by attorneys that were previously in charge of healthcare prosecutions and that now lend their insight and knowledge to our clients. All of them, as well as former federal prosecutor Lynette Byrd and founding principal Dr. Nick Oberheiden, have significant experience in healthcare matters and we help clients accused of fraud on a daily basis. In a nutshell, our competence is based on three columns:

  • Government Experience. As mentioned, our attorneys have profound government experience. Many of us were federal healthcare prosecutors and all of us have handled a substantial amount of healthcare cases to deserve the label “very experienced.” This background and demonstrated experience with government actions is a huge advantage when it comes to representing clients. Our attorneys have a name and a reputation and we don’t need to convince the government lawyers that we know what we are doing. Instead, the government knows that when we are on the case, it is time to impress us with their alleged evidence or risk dismissals.
  • Industry Knowledge. Because hospice fraud charges may often stem from billing and coding errors, intrinsic understanding of applicable protocols and regulations is a prerequisite to doing a good job. Our attorneys have analyzed, reviewed, and defended approximately 500,000 billed claims. Our focus is the healthcare industry, and we have significant experience with legal, financial, and operational issues surrounding hospice care and home health care centers.
  • Our Track Record. As the outcomes of previously handled cases demonstrate, our attorneys are at the forefront of healthcare fraud defense strategies. Our track record of successful case outcomes, dismissals, and avoidance of criminal charges is unparalleled, unmatched, and unrivaled.

Our Track Record

  • Medicare Fraud Investigations by the Department of Justice and the U.S. Attorney’s Office
    Result: No criminal charges.
  • Medicare Fraud Investigation by the Department of Health and Human Services and the Office of Inspector General
    Result: No criminal charges.
  • Medicare Fraud Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services
    Result: No criminal charges.
  • Medicare Fraud Investigation by the Office of Inspector General for alleged False Claims Act
    Result: No criminal charges.
  • Medicare Fraud Investigation by the Department of Health and Human Services.
    Result: No criminal charges.
  • Medicare Fraud Investigation by the Office of Inspector General.
    Result: No criminal charges.
  • Investigation by the Office of Inspector General for alleged False Claims Act violations.
    Result: No criminal charges.
  • Investigation by various branches of the federal government for alleged False Claims Act, Stark Law, and Medicare violations.
    Result: No criminal charges.
  • Investigation by the Department of Defense for alleged Tricare fraud.
    Result: No criminal charges.
  • Investigation by the Department of Justice for alleged Medicare Fraud.
    Result: No criminal charges.
  • Investigation by the Department of Health and Human Services for alleged Stark Law violations.
    Result: No criminal charges.
  • Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for alleged Medicare Fraud.
    Result: No criminal charges.

Primary Contacts

Dr. Nick Oberheiden has represented clients in Medicare Fraud, Tricare Fraud, Qui Tams, False Claims Act, Stark Law, and anti-kickback proceedings before all federal agencies, including but not limited to the Office of Inspector General (OIG), the Department of Health and Human Services (HHS), the Department of Defense (DOD), the Department of Justice (DOJ), and the Department of Labor (DOL). Dr. Oberheiden is trained in negotiation skills by Harvard Law School and holds a Juris Doctor as well as a Ph.D. in law.
E-mail: nick@federal-lawyer.com
Phone: (214) 469-9009

Lynette S. Byrd focuses her practice on civil and criminal litigation, Medicare and insurance audits, and general advice and counseling in health care law. She is a former Assistant United States Attorney with years of substantial trial experience under her belt who merges excellent litigation skills with profound understanding of the law.
E-mail: lsb@federal-lawyer.com
Phone: (214) 469-9009

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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