ADMITTING UNQUALIFIED PATIENTS INTO HOSPICE CARE
Whistleblowers have assisted the US Government is combating hospice fraud. Per Medicare rules, hospices can only admit, and receive payment for, patients who are “terminally ill.” To be considered terminally ill, a physician must determine that the patient has less than six months to live if the disease was to run its normal course.
The core requirement for Medicare covered hospice services is that the patient is terminally ill (i.e. less than six months to live). However, hospice providers have defrauded the federal government by admitting patients into hospice treatment that are not terminally ill. As a result, the government is defrauded because it is paying for hospice care for individuals who do not need such treatment.
In some instances, this can happen as a result of the way the hospice provider compensates its marketing representatives. Some hospices pay their marketing representatives based upon the number of admissions they obtain. Many times this comes in the form of an admissions quota. Also, hospice providers may give their marketing representatives bonuses based upon the amount of admissions they bring in. This can create pressure and an incentive for marketing representatives to have patients admitted, even if they do not qualify for such care.
FALSIFYING AND FORGING PATIENT DOCUMENTS, CERTIFICATIONS, AND RECERTIFICATIONS
Hospice providers have also engaged in fraud by falsifying and forging patient documents. Many times this hospice fraud occurs in the context of backdating patient certifications and recertifications.
In order for a hospice patient to remain covered under Medicare, the hospice must do a face-to-face encounter with the patient before the start of the patient’s third benefit period, and then subsequently for each new benefit period thereafter. This face-to-face encounter is used to establish the patient’s continued eligibility for hospice care (i.e. the patient is terminally ill). If the hospice fails to perform this face-t0-face encounter before the new benefit period, the patient is no longer considered eligible for Medicare’s hospice benefit.
Providers have engaged in hospice fraud by failing to perform the required face-to-face encounter, which means they don’t get paid for providing the patient with hospice services, and forging and/or falsifying the patient documents to reflect that the encounter was performed before the new benefit period. By doing this, hospice provides are able to fraudulently collect payments from government health care programs that they are not entitled to receive because they patient has not been re-certified as hospice eligible.
No Fees Without Recovery
Ross M. Wolfe and the Weiser Law Firm litigate whistleblower lawsuits on a contingent fee basis, so whistleblowers do not pay attorneys’ fees or court costs unless there is a recovery.
Please contact Ross M. Wolfe if you would like to speak with a whistleblower attorney for more information about the whistleblower process, providing home health services to unqualified individuals or to schedule a free confidential consultation to discuss your potential case.