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Do You Need a Hospice Fraud Lawyer?

Do You Need a Hospice Fraud Lawyer?
  • Are you a whistleblower who has uncovered hospice fraud?

  • Is your employer abusing Medicare by improperly certifying patients for end-of-life care?
  • Do you know of doctors who are being paid for hospice referrals?
  • Have you been told to stop asking questions — or else?

If you're a hospice fraud whistleblower, the law is on your side.

Congress has passed laws that forbid retaliation against whistleblowers in the hospice industry — and that offer monetary rewards for turning in wrongdoers. Under the False Claims Act (FCA), for instance, the government may reward a Medicare whistleblower with up to 30% of the recovered funds. Similar laws exist in many states.

Many hospices are breaking Medicare rules on end-of-life benefits by admitting patients who don't qualify as incurable, then re-certifying them in order to keep payments flowing. Some hospices also drug patients far beyond their palliative needs. These practices harm both taxpayers and the patients themselves — especially since Medicare won't cover life-extending treatment for patients who claim hospice benefits, even if they're not really terminal.

If you've witnessed Medicare fraud in your workplace but are scared to speak up, several laws may protect you.

The Employment Law Group® law firm is experienced in representing employees who blow the whistle on fraudulent healthcare practices. Our attorneys have represented doctors, nurses, Medicare billing specialists, accountants, administrators, and other employees in their whistleblower claims. We have a number of hospice cases currently in progress.

In 2015, TELG client Cheryl Sifford — an experienced hospice nurse — was awarded $440,000 for reporting her former employer, an Arizona hospice accused of admitting patients who weren’t terminally ill. We help clients pursue non-hospice healthcare claims, too: In March 2016, for instance, our client Joseph Ting was awarded more than $7 million for revealing overbilling by 21st Century Oncology, a large cancer-treatment company.

The U.S. government also gave a TELG client 20% of its settlement with a sleep-disorder facility that pretended to diagnose sleep problems. And two TELG clients helped the government reach a $2.8 million settlement with clinics accused of billing Medicare for physical therapy performed by unqualified staff members.

The False Claims Act makes it illegal to bill the U.S. government under false pretenses — for instance, by seeking Medicare reimbursement for unqualified hospice treatment. The law provides a financial incentive for whistleblowers to report such wrongdoing by filing a lawsuit on behalf of taxpayers. This "qui tam" provision allows prevailing plaintiffs to receive up to 30% of the money returned to U.S. coffers.

If a whistleblower gets fired for reporting fraud, or suffers other retaliation, the FCA demands that the harm be reversed entirely: Successful plaintiffs can get their jobs back — and may get damages including attorney fees and payment for emotional distress.

As with all legal claims, deadlines are crucial. If you have been punished for drawing attention to shady behavior at a hospice, you must file a retaliation claim under the FCA within three years. The statute of limitations for the underling fraud generally is six years under the FCA — or 10 years in a few situations. Other laws, including some relevant state laws, may demand faster action.

FREQUENTLY ASKED QUESTIONS

How are hospice whistleblowers rewarded?

As an inducement for people to expose fraud against programs such as Medicare, the False Claims Act allows whistleblowers to receive up to 30% of any money the U.S. government recovers as a result of their litigation. Since a large percentage of hospice care is funded by Medicare’s end-of-life benefit — and since the federal government faces a growing wave of hospice fraud — the FCA is a powerful incentive for hospice whistleblowers. Depending on your state, however, other rewards statutes may also apply.

How does hospice fraud work?

Medicare is a government health insurance program for older people. It includes a benefit for hospice care — end-of-life care that is intended to ease suffering, but not to cure any condition. This is sometimes called palliative care.

In order to receive Medicare’s hospice benefit, a patient should be certified with a condition that, in its normal course, is expected to end in death within six months. A minority of unethical hospices, however, accept older patients who don’t meet this standard — or, in some cases, who aren’t even terminally ill. As a result, they may collect benefits for months or years longer than intended.

Meanwhile the elderly patients, who often lack an effective representative and are already disoriented, may be kept docile via sedatives and painkillers. Because Medicare thinks they are terminally ill, it doesn’t cover any drugs that are intended to cure them.

Common types of hospice fraud

If you work in a hospice, or for a company that provides in-home hospice care, you may have witnessed some of these practices:

  • False certification: To qualify for hospice benefits under Medicare, a patient normally should be certified by a doctor to have six months of life remaining. Some hospice providers may ignore this requirement, or may obtain a false certification.
  • Kickbacks: Some hospices may offer money, gifts, or other favors to doctors who refer lucrative patients to their facilities.
  • Billing fraud: Hospice providers may bill for services they did not deliver, such as licensed massage therapy, or for equipment or supplies that weren’t used; or they may bill for higher levels of care than they delivered, a practice known as upcoding.
  • Fraudulent treatment plans: Hospice providers may falsify patient records to justify unneeded services such as stronger painkilling regimes — even if a patient is showing no discomfort.
  • Self-referrals: Some doctors may have an ownership stake in a provider of hospice care, or a family member may have a stake. This is legal — but such doctors are not allowed to refer their patients to these hospice companies, because it is a conflict of interest.

How do I report hospice fraud?

Low-level hospice fraud can be reported via StopMedicareFraud.gov, a joint Web site of the Department of Justice and the Department of Health and Human Services.

If you are a healthcare worker who knows about serious hospice fraud — or if you have faced retaliation in connection with such fraud — you may want to file a whistleblower lawsuit under the False Claims Act, a state equivalent, or both. There are strict standards for such suits: You must supply important information that the government doesn’t already know, for example, and you shouldn’t be a participant in the fraud yourself.

Blowing the whistle on hospice fraud isn’t a simple matter. If you would like to have an experienced law firm on your side, please contact us.

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