Whistleblower Law Blog

Justice Department Joins False Claims Act Medicare Fraud Lawsuit

The Justice Department announced last week that it will join the False Claims Act qui tam lawsuit filed against Hospice of the Comforter Inc. (HOTCI) by Douglas Stone, HOTCI’s former vice-president of finance. Stone’s suit alleges that HOTCI engaged in fraudulent Medicare billing.

According to the lawsuit, HOTCI’s chief executive officer verbally instructed HOTCI employees to admit for hospice care patients with Medicare coverage, without determining whether those patients were in fact eligible for hospice benefits. Medicare hospice benefits are reserved for terminally ill patients with a life expectancy of six months or less. Under hospice care, because the patient has elected to end curative care and allow the disease to run its normal course, medical treatment is focused on providing patients with relief from pain and stress. Once informed by its Medicare contractor that a formal audit would be conducted, HOTCI formed an internal committee to review hospice eligibility of its Medicare patients.  Between 2009 and 2010, the company had to discharge at least 150 patients after determining that they were ineligible for Medicare hospice benefits.

Robert O’Neill, U.S. Attorney for the Middle District of Florida, stated:

“Some of the most vulnerable people in our district rely on hospice services… It is critically important that Medicare remains solvent in order to provide hospice benefits, and that we confront those whose practices in this area put economic gain before patient care.”

The Employment Law Group® law firm’s whistleblower attorneys have helped many clients file suit against employers that fraudulently bill the U.S. government, and have established favorable precedents under the retaliation provision of the False Claims Act.

Tagged: ,

decorative line