Hospice care fraud is a particularly egregious form of fraud that revolves around care for the most vulnerable in our society. Hospice care, also referred to as end-of-life care, is medical, psychological and spiritual care for the incurably ill, provided by health care professionals and volunteers. A Medicare or Medicaid beneficiary is typically eligible to receive hospice care after a physician has given them a life expectancy of six months or less. Hospice care may be administered in a hospice center, a hospital facility, a skilled nursing facility, or as part of a home health care program.
Hospice care fraud is not a dying industry. When hospice and nursing home staff blow the whistle on fraud, it sends a message to everyone in the industry that people come first, and that unethical, profit-first actions will not be tolerated.
Hospice services are provided through hospice providers, home care agencies, skilled nursing facilities or facilities affiliated with hospitals. It is estimated that 1.7 million Americans receive hospice care in a given year, and the Centers for Medicaid and Medicare have seen dramatic increases in hospice care expenditures.
In 1996, Medicare spent around $2 billion on hospice care. That amount has since ballooned to more than $15 billion annually. Heavy demand from beneficiaries, coupled with the dramatic rise in Medicare payments to hospices has created a rise in for-profit hospice agencies participating in Medicare. The amount of money changing hands has also made government healthcare programs vulnerable to hospice care fraud.
This is why the government and taxpayers rely on hospice fraud whistleblowers to expose bad actors and preserve the integrity of our healthcare system. Whistleblowers have helped the government recover billions in fraudulently billed Medicare and Medicaid funds and have been vital in deterring Medicare and Medicaid fraud and abuse.
Caring for the physical and mental needs of patients is among the highest of callings. It is why you became a nurse.
Today, unfortunately, too many hospitals, nursing homes, community mental health centers and hospice providers have been blinded by greed. Patient admissions and treatment are manipulated to maximize benefit and billings, rather than provide needed and medically necessary health care.
If you find this conduct disturbing, you can make a difference. Call Wisner Baum for a privileged and confidential discussion about your concerns. It’s the right thing to do and you may also be entitled to a reward from the federal government.
"Whistleblowers play an incredibly important role in holding providers and companies accountable for committing fraud against the government." -Whisteblower attorney, Mark Schlein, in Home Health Care News. Read the article here.
Read the Medscape interview of Wisner Baum whistleblower attorney, Mark Schlein: Physicians Misjudge a Terminal Patient's Life Span: Is It Fraud?
Hospice fraud can occur in a variety of ways, but none are more worrisome than kickback based relationships between nursing homes and hospices. Nursing homes often enter exclusive or semi-exclusive arrangements with hospices to provide services to their terminally ill patients.
From a financial standpoint, hospices view nursing homes as a sizeable pool of potential patients. In addition, nursing home hospice patients are generally more profitable than hospice patients receiving at-home care.
Hospice staffs also provides patient care, allowing the nursing home to serve more patients with the same or fewer employees. This creates an incentive for some hospice providers to pay kickbacks to nursing home facilities for patient referrals. The result is a growing number of hospice patients who receive hospice care that is not medically and legally proper. Under the Anti-Kickback Statute, it is illegal to “knowingly or willfully solicit, receive, offer or pay anything of value to induce referrals or items or services payable by a federal healthcare program.”
These kickbacks can take a variety of forms:
Hospice facilities providing free or below market value skilled nursing services to a nursing home, services for which the nursing home is already receiving Medicare payments. The hospice does this with the expectation that when the patient is eligible for hospice care, that hospice company will be contracted to provide hospice services at the nursing home.
Wisner Baum Announces Multi-Million Dollar Settlement in Healthcare Fraud Whistleblower Case Against the San Diego Hospice & Palliative Care Corporation.
The following hospice care fraud cases illustrate some common themes found in hospice fraud, as well as the role that whistleblowers play in uncovering fraudulent Medicare and Medicaid billing.
Whistleblowers who are considering legal action are encouraged to investigate their legal options as soon as possible. Wisner Baum’s whistleblower attorneys have experience handling hospice care fraud litigation and can answer any questions you may have. Call us today at (310) 207-3233 for more information.
"Wisner Baum gave exceptional attention to all aspects of the case, detailed inquiry, and tenacious overview of all the information submitted. The paralegals are efficient and diligent. I was completely surprised to find an empathic personal message to take care of my own health during the challenging time of being a full-time caretaker.*"
In May of 2019, the jury in the case of Pilliod et al. v, Monsanto Company ordered the agrochemical giant to pay $2.055 billion in damages to the plaintiffs, Alva and Alberta Pilliod, a Bay Area couple in their 70s. R. Brent Wisner served as co-lead trial attorney for the Pilliods, delivering the opening and closing statements and cross-examining several of Monsanto’s experts. Wisner Baum managing shareholder, Michael Baum and attorney Pedram Esfandiary also served on the trial team in the Pilliod case.
The judge later reduced their award to $87M. Monsanto appealed the Pilliod’s verdict which the California Court of Appeal for the First Appellate District denied on August 9, 2021. Monsanto then requested the California Supreme Court review the appeal’s court decision, which the court denied on Nov. 17, 2021. Monsanto (Bayer) then submitted a petition for a writ of certiorari with the U.S. Supreme Court which SCOTUS denied on June 27, 2022, allowing the final judgment of $87M to remain intact.
$289.2 million jury verdict in Monsanto Roundup trial
Wisner Baum co-represented Dewayne “Lee” Johnson in the first Roundup cancer lawsuit to proceed to trial. On Aug. 10, 2018, a San Francisco jury ordered Monsanto to pay $39.25 million in compensatory damages and $250 million in punitive damages to Mr. Johnson, a former groundskeeper who alleged exposure to Monsanto’s herbicides caused him to develop terminal non-Hodgkin lymphoma.
Months after the jury verdict, the judge overseeing the trial reduced the punitive damages to $39.25 million. Mr. Johnson decided to accept the remittitur, bringing the adjusted amount awarded to Mr. Johnson $78.5 million.
Monsanto (Bayer) appealed the verdict and Johnson cross appealed. On July 20, 2020, the First Circuit Court of Appeals upheld the verdict against Monsanto but reduced Mr. Johnson’s award to $20.5 million. The company chose not to take the case to the U.S. Supreme Court, ending the litigation.
In 2016, Wisner Baum attorney Timothy A. Loranger and six other attorneys in the Plaintiffs’ Management Committee were able to secure a $265 million settlement for victims of the 2015 Amtrak 188 derailment in Philadelphia, one of the largest in the U.S. for 2016.
