Back To HEALTHCARE FRAUD
Like nearly every entity that participates in the U.S. healthcare system, providers of hospice services—a type of care that focuses on the comfort and quality of life of people who are terminally ill—can and do commit healthcare fraud against state and federal healthcare programs. Fraud by hospice providers, like other frauds against the government, are actionable under the False Claims Act.
The most common form of hospice fraud is admitting Medicare and Medicaid beneficiaries who are not eligible for hospice into hospice programs, and billing those federal healthcare programs for those services. To be eligible for Medicare or Medicaid coverage of hospice care, a medical provider must certify that the patient’s condition is likely to become terminal in the upcoming six months. If a hospice provider has a large proportion of patients in palliative care for over six months, that can be seen as a red flag.
Because hospice care is supposed to be palliative and not targeted at curing any terminal conditions, this fraud shortchanges both patients and taxpayers. Taxpayers are charged for care that the program was never meant to cover, and patients can be denied potentially life-saving treatments if they have been falsely deemed as terminally ill and Medicare does not cover those treatments for terminally ill beneficiaries.
In July 2024, Kindred Care, one of the nation’s largest hospice providers, agreed to pay roughly $20 million to resolve allegations that the company was falsely categorizing patients as terminally ill, and thus eligible for hospice care, when they were not in fact terminally ill. This type of fraud is common—the Kindred Care settlement resolved at least nine lawsuits, all brought by one or more whistleblowers. Similarly, in May 2024, Elara Caring, a hospice provider in Texas, agreed to pay $4.2 million to resolve similar allegations in a case also initiated by a whistleblower. And in 2022, yet another hospice provider paid over $1 million to settle similar claims.
Other hospice schemes include overprescribing drugs that hospices provide to patients and billing federal healthcare programs for those prescriptions. Common schemes that apply to every part of the healthcare system also can impact hospice providers, schemes such as billing for physicians with improper credentials or billing for services tainted by kickbacks can all violate the False Claims Act. In July 2024, a Georgia hospice paid over $1.2 million to resolve allegations that it’s claims resulted from kickbacks.
Hospice fraud is wasteful for taxpayers and dangerous for patients, and those who commit it may be liable under the False Claims Act, a law that empowers whistleblowers to detect and expose fraud against the government.
Under the FCA, whistleblowers can bring lawsuits against healthcare providers, vendors, and drug companies who they allege violate the law. As an incentive, whistleblowers can be rewarded 15-30% of the amount the defendant ultimately pays the government as a result of the case.
Whistleblower Partners has secured multiple high-profile wins in this area and can help you assess whether you might have a case. If you would like more information or would like to speak to an attorney at Whistleblower Partners, please contact us for a confidential consultation.
These descriptions of hospice fraud are general in nature and do not constitute legal advice. Hospice fraud is complex and ever-evolving. The attorneys at Whistleblower Partners understand the complicated, constantly changing legal landscape and are happy to discuss any potential matter further.
If you would like more information or would like to speak to an attorney at Whistleblower Partners, please contact us for a confidential consultation.
