A director at a Fort Myers, Florida, Hospice center will receive more than $600,000 as a whistleblower award for her role in leading the U.S. government to a $2.3 million settlement that resolves allegations of Medicare and Medicaid fraud.

Margaret Peters, the former Director of Hospice Care at Hope Hospice of Fort Myers, filed a False Claims Act lawsuit on behalf of the U.S. against her employer alleging that it knowingly billed Medicare, Medicaid and TRICARE for services it provided to patients who were not terminally ill.

In many cases, Hope Hospice falsely billed the federal and state health care programs for higher levels of patient care so it could collect more money in reimbursements, the U.S. Depart of Justice (DOJ) said in its announcement of the settlement.

Hospice provides end-of-life care to terminally ill patients with a focus on making the patient comfortable and providing them with relief from the symptoms, pain, and stress of their illness. Patients admitted into hospice care generally stop receiving coverage for medical care aimed at curing their illness. Medicare considers patients to be terminally ill and eligible for hospice care when they have a life expectancy of six months or less.

There are four levels of hospice care: routine home care, continuous home care, inpatient respite care, and general inpatient (GIP). Each level of care bills at a different rate, with GIP being the most intensive and costliest.

According to the whistleblower complaint, Hope Hospice billed federal health care programs for GIP levels of care for patients who did not qualify for that level of care. In some cases, Hope Hospice billed Medicare and other programs for more than four years of hospice care for patients who weren’t terminally ill.

The U.S. Justice Department investigated Ms. Peters’ whistleblower allegations and determined that Hope Hospice engaged in its fraudulent billing scheme from July 1, 2012, to June 30, 2016.

In addition to returning $2.3 million to the U.S., the settlement also required Hope Hospice to enter into a Corporate Integrity Agreement, which subjects it to closer regulatory scrutiny by the investigative arm of the Department of Health and Human Services (HHS) and requires it to take measures to ensure it complies with Medicare and Medicaid rules.

“Hospice care has brought peace of mind and reduced suffering for so many Floridians and their families. It is vital that we ensure this compassionate health care service is not exploited and that [patients] nearing the end of their journey are able to access these end-of-life resources to help bring dignity and peace to those with terminal illnesses,” said Florida Attorney General Ashley Moody.

Whistleblower litigation

If you have any questions about whether you qualify as a whistleblower, contact one of the lawyers on our firm’s Whistleblower Litigation Team for a free and confidential evaluation of your claim. Beasley Allen lawyers Larry GolstonLance GouldPaul EvansLeslie PesciaLeon HamptonTyner Helms and Lauren Miles are working in this area of law known as “qui tam” cases. A lawyer on the team will be glad to discuss the potential claim with you either in person or by phone.

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