A Minnesota-based hospice care provider has agreed to pay the U.S. $18 million to settle allegations that it violated the False Claims Act by billing Medicare for end-of-life care to patients who were not eligible to receive Hospice care because they weren’t terminally ill.
According to the U.S. Department of Justice (DOJ), a group of former employees of Evercare Hospice, now known as Optum Palliative and Hospice Care (Palliative), sued the company under the whistleblower provisions of the False Claims Act, alleging it knowingly billed Medicare for hospice care that patients didn’t need.
When a terminally ill Medicare patient enters hospice care, Medicare stops covering traditional medical care designed to improve or heal the patient, shifting resources to comfort the patient. Only Medicare patients who have a life expectancy of six months or less are considered terminally ill and eligible for the Medicare hospice benefit.
The government investigated the whistleblowers’ allegations and found that Evercare routinely billed Medicare for unnecessary hospice care from the beginning of 2007 through the end of 2013. Federal prosecutors claim Evercare’s business practices were designed to maximize the number of patients it could bill Medicare for regardless of whether the patients were terminally ill or needed hospice care.
According to the government’s complaint, Evercare achieved higher patient enrollment and Medicare billings by discouraging doctors from recommending that ineligible patients be discharged from hospice and failing to ensure that nurses accurately and completely documented patients’ conditions in the medical records.
“The decision to put someone into hospice care is an emotionally wrenching one for the patient and the patient’s family,” said U.S. Attorney John Walsh for the District of Colorado, who helped prosecute the case. “When hospice companies exploit and overbill Medicare by having people in hospice when they do not belong there, it jeopardizes this important benefit for others. “
Source: U.S. Department of Justice