United States Settles False Claims Act Allegations Against Hospice Of Citrus County For More Than $3 Million
Jacksonville, Florida B U.S. Attorney A. Lee Bentley, III announces that the United States has settled allegations that a hospice company located in Lecanto, Florida knowingly billed the government for medically unnecessary and undocumented hospice services. The allegations resolved included liability under the False Claims Act.
The government has reached a settlement with Hospice of Citrus County (“HOCC”). In reaching this settlement, the parties resolved allegations that HOCC knowingly submitting false claims to the Medicare and Medicaid programs for medically unnecessary hospice care of certain patients who had lengths of stays greater than 1,000 days. Typically, federal healthcare programs only pay for hospice care when patients are in a terminal condition and are expected to live for less than six months. Despite this principle, HOCC treated more than 50 patients for lengths of stays in excess of 3 years.
Specifically, between June 1, 2009, and March 15, 2015, HOCC treated at least 52 patients with lengths of stay in excess of 1,000 days. The government contends that for those 52 patients, HOCC either knowingly or recklessly failed to document a valid basis for the initial start of hospice care and/or subsequent hospice coverage. The failure in documentation included no support for the length of hospice services; patient files that failed to document basic patient characteristics; and patient records that were either unsigned or signed with inconsistent practitioner information.
In some cases, patients were admitted to HOCC simply because their spouse was in hospice care. In other cases, patients were admitted to HOCC under the pretense of having a terminal illness, but then cleared for multiple, lengthy, out-of-state trips over the course of five years. The government has agreed to accept $3,022,000 to resolve these allegations.
“Unfortunately, some healthcare providers seek to defraud Medicare and Medicaid by billing for unnecessary hospice services,” stated U.S. Attorney Bentley. “Left unchecked, this misconduct would deplete funds available for terminally ill patients desperately in need of the relief that hospice care provides.”
This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by the Attorney General and the Secretary of Health and Human Services. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in this effort is the False Claims Act. Since January 2009, the Justice Department has recovered more than $26.2 billion through False Claims Act cases, with more than $16.4 billion of that amount recovered in cases involving fraud against federal health care programs.
"Sticking taxpayers with a bill for unnecessary health care services such as hospice care will never be tolerated,” said Special Agent in Charge Shimon R. Richmond of the U.S. Health and Human Services, Office of the Inspector General. “Working shoulder to shoulder with our law enforcement partners, we will tirelessly pursue health care companies that threaten the integrity of Federal health care programs.”
This case was investigated by the Department of Health and Human Services Office of Inspector General, the Florida Attorney General’s Medicaid Fraud Control Unit, and Assistant United States Attorney Jason Mehta.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
Legal Filing located at: https://oig.hhs.gov/fraud/cia/agreements/Hospice_of_Citrus_and_The_Nature_Coast_Inc_11042015.pdf
Source: Department of Justice - Middle District of Florida - https://www.justice.gov/usao-mdfl/pr/united-states-settles-false-claims-act-allegations-against-hospice-citrus-county-more-3