Alive Hospice has paid more than $1.5 million to the government to resolve whistleblower allegations. The whistleblower complaint alleged Alive was overbilling Medicare and TennCare for the services provided at the hospice. Medicare and TennCare reimburse a non-profit for hospice care, and these reimbursements depend on the level of care provided by the hospice.
One level of reimbursement is for general inpatient services. General impatient services are for basic pain control and other such services that cannot be performed at the patient’s home. This level is one of the higher reimbursement levels, and it was alleged that Alive was submitting claims to Medicare and TennCare for general patient care for patients who did not qualify for the care.
There are limited funds for such care and this type of fraud depletes the funds, thus leaving insufficient funds for the patients who really need and qualify for this care. Taking advantage of patients at the end of their lives, when comfort and care are most needed, is something the government does not tolerate.
Alive agreed to a settlement where they paid a total of $1,548,220 split between the government, the State of Tennessee, and the whistleblower. The State of Tennessee will receive $102,088 and the whistleblower, a triage nurse, will receive $263,197.
The nurse brought her claim under the qui tam, or whistleblower, provisions of the Federal False Claims Act. This provision protects both patients and taxpayers from fraud by allowing private citizens with knowledge of false claims to bring suits on behalf of the government and share in the recovery as an incentive for coming forward with valuable information about fraud, waste and other wrongdoing. This ensures the tax money allotted for Medicare hospice benefits are being used to provide comfort and care to the patients who need it.
Whistleblower incentives under the False Claims Act include 15 to 30 percent of the funds the government recovers. Whistleblower incentives have helped the government (1) detect more fraud, (2) ensure money intended for health care is properly spent on health care, and (3) deter other companies from committing the same fraud.
If you are aware of fraud being committed against the federal or state governments, you could be rewarded for doing the right thing by reporting the fraud. If you have any questions about whether you qualify as a whistleblower then please feel free to 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: Andrew Brashier, Archie Grubb, Larry Golston or Lance Gould.