Hospice Care Fraud Whistleblowers
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.
- A hospice nurse, represented by Wisner Baum whistleblower attorney Mark Schlein, filed a whistleblower lawsuit in 2012 that resulted in a multimillion dollar settlement against a San Diego hospice care corporation. The whistleblower, who received a reward of around $1 million, claimed in the qui tam lawsuit that San Diego Hospice admitted patients who were not eligible for hospice services.
- The U.S. government joined a hospice care whistleblower lawsuit filed by two former employees of a company that provides hospice services across the U.S. The suit alleged that the company pressured employees and physicians to admit and retain patients who were not terminally ill and disregarded physician’s decisions that patients should be discharged.
- The U.S. Attorney’s Office filed a complaint against a Philadelphia provider of hospice services, charging the company with submitting “false claims and records, including fabricated records, to Medicare for purported hospice care for patients who were not terminally ill, and thus not eligible for the Medicare hospice benefit.” The company also submitted false claims and records for crisis care services that were not necessary or not actually provided. Crisis care services are more expensive and meant only for patients experiencing acute medical symptoms that require immediate short-term nursing services to remain at home. The charges were originally brought in a qui tam hospice lawsuit filed by two whistleblowers who were former employees of the hospice provider.
- A federal grand jury returned an indictment charging an Oklahoma hospice facility with conspiring to conceal the true medical condition of its patients. The indictment alleged that medical records and nursing notes were falsified to make it appear that necessary assessments had been conducted, when they were not and to make it appear that the patients were in worse health than they actually were.
Taking Legal Action
The hospice care fraud lawsuits mentioned above are authorized by a federal law known as the False Claims Act (FCA). This law permits private citizens who are aware of fraudulent activity to sue individuals or companies on behalf of the U.S. government to recover any money received through the submission of false claims.
Whistleblowers may be eligible to receive between 15 percent and 25 percent of any amount recovered through a trial or settlement if the Department of Justice decides to intervene in the case. If the government does not join the lawsuit, the whistleblower may still proceed with his or her case and may be eligible to receive an award of up to 30 percent of any successful recovery.
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 (855) 948-5098 for more information.