Recently, the Department of Justice announced Evercare Hospice and Palliative Care have agreed to pay $18 million in order to settle alleged False Claims Act (FCA) violations. These allegations purported that the providers were receiving Medicare reimbursement for patients placed in hospice care, even though the patients were not eligible for hospice. Hospice care is an end-of-life care reserved for those who are terminally ill.
According to Medicare, for one to be terminally ill, and thus eligible for hospice care, their life expectancy must be six months or less. Once a patient is placed in hospice care, Medicare no longer covers customary medical care designed to help the patient recover. After a patient decides on hospice care, efforts are focused on quality of life instead of curative measures.
The government’s complaint against these hospice providers alleged that the providers’ business practices maximized the number of patients for whom they could bill Medicare, regardless of whether the patients needed or were eligible for hospice. The complaint further asserts that the providers discouraged doctors from discharging ineligible patients from hospice care.
Concerning the settlement, the Principal Deputy Assistant Attorney General Benjamin C. Mizer stated, “Today’s settlement reflects the Justice Department’s continuing efforts to combat health care fraud and protect the nation’s elderly and most vulnerable citizens. Our seniors rely on the hospice program to provide them with quality care, dignity and respect when they are terminally ill and need end-of-life care. It is, therefore, critically important that we hold accountable those hospice providers that bill for medically unnecessary services in order to get higher reimbursements from the Medicare program. Such abuses threaten a vulnerable population and jeopardize this important benefit for others under the program. The Justice Department will continue to protect taxpayer dollars and ensure that this critical benefit is available for Medicare patients who truly need it.”
When a person defrauds the government, they are stealing funds from critical federal programs that are financed by taxpayers. In this war against fraud, ordinary citizens are using the FCA to aid the government in recovering defrauded money.
The FCA provides an avenue for citizens to sue on behalf of the government when they know of someone defrauding the government. This avenue is known as the qui tam provision, and not only does it provide an avenue, but the qui tam provision also offers incentives for citizens to step forward as whistleblowers. These incentives include 15 to 30 percent of the monies recovered by the government.
The case against Evercare Hospice and Palliative Care was originally brought under the qui tam provision of the FCA by former employees of the providers. These former employees are now entitled to receive up to $5.4 million for their part in the case.
Are you aware of fraud being committed against the federal government, or a state government? If so, the FCA can protect and reward you for doing the right thing by reporting the fraud. If you have any questions about whether you qualify as a whistleblower, please contact an attorney at Beasley Allen for a free and confidential evaluation of your claim. There is a contact form on this website, or you may email one of the lawyers on our whistleblower litigation team: Archie Grubb, Larry Golston, Lance Gould or Andrew Brashier.
Source: U.S. Department of Justice