Consumer Fraud

Hospice Whistleblowers Ask Appeals Court to Hear Medicare Fraud Case

A group of whistleblowers is asking the Third Circuit Court of Appeals to revive their False Claims Act lawsuit accusing a New Jersey hospice provider of falsifying patient records to make them appear eligible for end-of-life care.

woman in hospital bed Hospice Whistleblowers Ask Appeals Court to Hear Medicare Fraud CaseFour former employees of Care Alternatives Inc. of Cranford, New Jersey, now known as Ascend Hospice, filed the whistleblower lawsuit in 2008, alleging the company pressured them and others to alter patients’ medical records to satisfy Medicare’s criteria for hospice eligibility.

The whistleblowers claimed that the company rewarded employees who complied with the alleged activity with bonuses.

Several False Claims Act lawsuits have been brought against hospice providers in the past. These cases typically allege that hospice providers admit patients to end-of-life care when the patients don’t need it. These schemes, when proven, are especially egregious because by going into hospice care, the patient cannot access other medical services that may be beneficial to him or her.

In the case of Care Alternatives, a New Jersey federal court found that the whistleblowers failed to present “sufficient evidence of falsity to raise a genuine dispute of material fact.”

U.S District Judge Jerome Simandle also found that the plaintiffs failed to present evidence that doctors received kickbacks to certify patients for hospice and they also did not accuse any doctors of certifying patients that the doctor believed to be ineligible for hospice, according to The New Jersey Law Journal.

Judge Simandle dismissed the case on Sept. 27, finding that the whistleblowers did not provide adequate evidence that Care Alternatives submitted false claims to Medicare when it billed the program for end-of-life care it rendered to certain patients.

“While we have the highest respect for Judge Simandle, we believe he was mistaken in following a theory called objective falsity, which was issued by a district court outside the Third Circuit,” a lawyer for the whistleblowers told The New Jersey Law Journal. “While several circuit courts have disavowed that theory, the Third Circuit has never ruled on this issue, and we are hopeful and confident that the Third Circuit will reverse the judge on this issue.”