Growing Problem Of Hospice Fraud
Fraud And Patient Abuse And Neglect
For-Profit Hospice Agencies
Hospice fraud in the United States is an increasing problem as the number of hospice patients has exploded over the past few years. From 2004 to 2008, the number of patients receiving hospice care in the United States grew almost 40% to nearly 1.5 million, and of the 2.5 million people who died in 2008, nearly one million were hospice patients. The overwhelming majority of people receiving hospice care receive federal benefits from the federal government through the Medicare or Medicaid programs. The health care providers who provide hospice services traditionally enroll in these programs to receive payments for eligible patients. The question of a person’s “eligibility” is the point at which fraud and false certifications of eligibility and neglect or abuse of a person fraudulently deemed eligible for hospice care intersect. Evans Law Firm, Inc. represents hospice patients and their families who are defrauded by unscrupulous agencies or neglected, abandoned or denied the medications they need because, contrary to the agency’s certification, they are not in reality terminally ill. Parties responsible for such fraud, abuse and neglect are liable for their actions under California Law. See Cal. Welf. & Inst. Code §§ 15610.07 (definition of abuse), 15610.57 (definition of neglect), and 15610.63 (definition of physical abuse); Cal. Gov’t Code § 12650 et seq. (California False Claims Act). The parties responsible for the fraud and abuse should be held accountable. If you have a loved one who has suffered from abuse or neglect in a hospice program in Los Angeles or elsewhere throughout California, call us today at (415)441-8669 or TOLL FREE 1-888-80EVANS (888-503-8267).
Recent Case Examples
In the first example, a hospice company that paid $24.7 million to settle an FCA case. The defendant operated hospices in 14 other states, too, including Alabama, Georgia, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Ohio, Pennsylvania, Texas, Virginia and Wisconsin. The alleged frauds were that patients were not eligible for hospice, (i.e., were not terminally ill), lack of documentation of terminal illnesses, and that the company marketed to potential patients with the promise of free medications, supplies, and the provision of home health aides. The company also entered into a 5-year Corporate Integrity Agreement with the government as part of the settlement. The qui tam relators received almost $5 million.
In the second example, authorities recently arrested a physician and health care marketer n federal charges stemming from a scheme that bilked Medicare out of more than $30 million for medically unnecessary hospice services provided to patients who were obtained through illegal kickbacks. According to court documents, the hospice companies involved billed Medicare and Medi-Cal for hospice services for patients who were not terminally ill. In some case, the companies submitted bills for services that were never provided. The government further claimed the companies submitted fraudulent certifications for some patients, including patients claimed to have examined, but who were never actually seen by the certifying physician. The indictment further claims that the hospice companies paid illegal kickbacks to a health care marketer for referrals.
The human toll of this kind of hospice fraud is staggering; millions of Americans are enrolled in hospice care every year and even if only a small percentage are admitted fraudulently to that care the numbers are still very large. If a patient who is not terminally ill is nevertheless admitted to hospice, he or she cannot get the medications needed to actually treat their illness. If you have a loved one who has suffered any kind of fraud or abuse or neglect in a nursing home or hospice program, call us at Evans Law Firm, Inc. right away at (415) 441-8669, or by email at firstname.lastname@example.org or TOLL FREE 1-888-80EVANS (888-503-8267).
 Patients and their families having credible information of any government fraud may also be able to bring a qui tam action on behalf of the State to recover money fraudulently paid out,and be eligible for a reward if the State recovers from the wrongdoers.
 Evans Law Firm, Inc. was not involved in either reported case in any way.