Dying in the United States when you are old and have a terminal illness can be exceedingly expensive, unless you can gain admittance to the Medicare hospice program. It was not until 1986 that we had permanent coverage for the costs of end-of-life care for those 65 and over who need them. (The benefit began in 1982 but was not made permanent at that time.)
Hospice provides end-of-life care characterized as palliative, which means no cure or curative treatment is sought. Instead, the patient is kept as comfortable as possible while they approach the end of life. Medicare rules state that, to qualify for hospice services, the patient must, in a doctor’s opinion, have less than six months to live. Should the patient live beyond six months, they are eligible to be recertified for an unlimited number of 60-day periods by the doctor. Obviously, no one really knows how long a terminal patient can or will live. The human spirit can be a remarkable thing, so the doctor is making their best and most educated guess as to how much time is left for the patient.
The only problem is, this situation leaves the door wide open for fraud and false claims.
In spring of 2016, a false claims case brought by the government against hospice provider AseraCare was dismissed by an Alabama judge. The government alleged that AseraCare presented false claims totaling more than $200 million for those deemed ineligible for hospice care. The judge said otherwise, stating that the allegations amounted to “conflicting views of physicians.” The decision is being appealed by the Justice Department, with the case currently before the 11th U.S. Circuit Court of Appeals.
There is much at stake, because hospice provides clear and needed benefits. In 2014, hospice services were delivered to almost 1.7 million people; the number is up from 2010’s figure of 1.38 million. That’s a lot of suffering people who have received relief. Not only that, hospice care provides positive benefits for the family of the patient; with hospice, they can develop more coping mechanisms and become better emotionally prepared for their loved one’s impending death.
And yet, hospice fraud darkens the picture and puts at risk the benefits that the dying need. In a September, 2016, report, the Office of Inspector General (OIG) for the Department of Health and Human Services called out the Centers for Medicare & Medicaid Services, stating that better oversight regarding payment of hospice claims is strongly needed. Another report released in 2016 indicated that, across the U.S., over $268 million was spent during 2012 alone on unnecessary hospice services for general inpatient care.
The hospice fraud problem has also hit close to home; an ongoing qui tam whistleblower suit against one health care organization providing hospice services in Columbia alleges that patients were admitted and recertified as needing hospice services when they were, in fact, ineligible.
Hospice care has come a long way in the past 34 years. But the fraudsters have learned a few tricks as well. It remains to be seen whether the OIG’s demand for reforms to hospice payments will happen and, if so, whether it will succeed. In the meantime, we rely on whistleblowers to come forward with any knowledge they might have regarding hospice fraud.
Making a difference.
If you think you have the facts needed to bring a whistleblower case, the experienced whistleblower attorneys at the Louthian Law Firm can review your case and help you file the appropriate disclosure statement. Under some circumstances, the government will intervene, or join in your lawsuit.
Your chances of succeeding are greater if your whistleblower claim is substantive, clear, and to the point. Because of this, meeting with a qualified whistleblower attorney can increase your chances of winning. The Louthian Law Firm can help you form your claim so that the government will be more inclined to intervene in your case; government intervention can sometimes increase the chances of recovering reward money. Even if the government decides not to intervene, it could still be a good idea to pursue your case without government involvement. Our strong support system can assist you through every step of the process.
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