Consumer Fraud

Whistleblower complaints prompt U.S. to sue Nevada hospice companies for false claims

whistleblower Whistleblower complaints prompt U.S. to sue Nevada hospice companies for false claimsThe U.S. Justice Department said that it has intervened in a whistleblower lawsuit against Creekside Hospice of Las Vegas, Nev., and a group of affiliated companies for allegedly submitting ineligible claims for hospice services to Medicare and Medicaid and inflating the cost of patient visits when seeking reimbursement from the federal health care programs.

Joanne Cretney-Tsosie and Veneta Lepera, who formerly worked as clinical managers for Creekside, filed complaints in federal court under the whistleblower provisions of the False Claims Act and in state court of the Nevada False Claims Act. Both the federal and Nevada statutes authorize private citizens to sue for fraud on behalf of the government and share up to 30 percent of any recovery resulting from their lawsuits. The statutes also give the federal government and the state of Nevada the option to intervene in False Claims suits brought by whistleblowers, effectively taking them over, as they have done in this case.

The U.S. alleged in its complaint that Creekside and its affiliated companies directed their staff to enroll patients in the hospice program regardless of the patient’s eligibility, sometimes instructing staff to falsify records after claims had already been submitted to Medicare for reimbursement to show that all requirements had been met.

The complaint also alleges that the companies instructed employees to alter medical records to make it appear that hospice doctors had conducted personal visits with the patients when such visits had not occurred in order to ensure reimbursement from Medicare and Medicaid.

Creekside management also “aggressively discouraged staff from permitting patients or their families to revoke their elections to accept hospice benefits” the complaint alleges. In many cases when the patient wasn’t terminally ill and experienced an improvement, Crrekside staff were discouraged from documenting known improvements in the patient’s health so that the government would continue to pay for the hospice services.

The lawsuit also claims that Creekside and the other companies overcharged Medicare and Medicaid by using billing codes to inflate claims for services performed. As a result, the Creekside companies “misspent tens of millions of taxpayer dollars from the Medicare and Medicaid programs,” the Justice Department said.

“The Medicare hospice benefit is intended to provide pain management and other palliative care to patients nearing the end of life, to help make them as comfortable as possible,” said Acting Assistant Attorney General Joyce Branda.  “Too often, however, companies abuse this critical service by using aggressive marketing tactics to pressure patients who do not need, and may be ill-served, by these services in order to get higher reimbursements from the government. The department will take swift action to protect taxpayer dollars and make sure that Medicare benefits are available to those who truly need them.”

Source:

U.S. Department of Justice