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Dec 2, 2022 by |

San Francisco Whistleblower Attorney: Blowing The Whistle On Hospice Fraud

ATTORNEY NEWSLETTER

Hospice Care Is Now A Huge For-Profit Industry

False Certifications To Inflate Profits

Lack Of Regulatory Oversight

Hospice care is end of life care where patients are certified by a physician with less than six months to live and forgo any curative treatment.  Today, half of all Americans who die each year die in hospice care. An estimated $22 billion is spent on hospice care annually, much of it paid by government programs like Medicare and Medicaid. Because these numbers are so large, hospice care has become an enormous for-profit business in the United States; within the last decade the number of hospices owned by private equity firms has tripled. The profit motive has also led to an increase in cases of fraud including inappropriate certifications for hospice care, illegal kickbacks to certifying physicians, and failure to provide the services paid for. In 2018, the Office of Inspector General at the Department of Health and Human Services estimated that inappropriate billing by hospice providers had cost taxpayers “hundreds of millions of dollars.” Others believe the figure to be far higher. Individuals with information of hospice fraud (known as “relators”) can bring whistleblower cases (known as qui tam actions) under the False Claims Act, 31 U.S.C. § 3729 et seq. and receive up to 15-30% of what the government recovers as a reward.  31 U.S.C. § 3730(d). The California whistleblower/qui tam attorneys at Evans Law Firm, Inc. represent individuals with credible information of any type of fraud against the government, including fraud for false hospice certifications.  If you have credible information for a whistleblower or qui tam case, call Evans Law Firm, Inc. today at (415) 441-8669 or TOLL FREE 1-888-80EVANS (888-503-8267)

Hospice Fraud

An article[1] in the current issue of The New Yorker by Ava Kofman explores the for-profit “hustle” of hospice care in contemporary America and describes some of the heartbreaking consequences for patients.  She reports on the questionable tactics of salespeople who recruit patients for hospice care and the lack of government oversight that allows hospice care providers to, in her words, “enlist family and friends to act as make-believe clients, lure addicts with the promise of free painkillers, dupe people into the program by claiming that it’s free home health care, or steal personal information to enroll “phantom patients.”” She describes a grim picture of some of the “providers” of hospice care and the consequences of little oversight for the industry:

A medical background is not required to enter the business. I’ve come across hospices owned by accountants; vacation-rental superhosts; a criminal-defense attorney who represented a hospice employee convicted of fraud and was later investigated for hospice fraud himself; and a man convicted of drug distribution who went on to fraudulently bill Medicare more than five million dollars for an end-of-life-care business that involved handling large quantities of narcotics.

Once a hospice is up and running, oversight is scarce. Regulations require surveyors to inspect hospice operations once every three years, even though complaints about quality of care are widespread. A government review of inspection reports from 2012 to 2016 found that the majority of all hospices had serious deficiencies, such as failures to train staff, manage pain, and treat bedsores. Still, regulators rarely punish bad actors. Between 2014 and 2017, according to the Government Accountability Office, only nineteen of the more than four thousand U.S. hospices were cut off from Medicare funding.

Because patients who enroll in the service forgo curative care, hospice may harm patients who aren’t actually dying. Sandy Morales, who until recently was a case manager at the California Senior Medicare Patrol hotline, told me about a cancer patient who’d lost access to his chemotherapy treatment after being put in hospice without his knowledge. Other unwitting recruits were denied kidney dialysis, mammograms, coverage for life-saving medications, or a place on the waiting list for a liver transplant. In response to concerns from families, Morales and her community partners recently posted warnings in Spanish and English in senior apartment buildings, libraries, and doughnut shops across the state. “Have you suddenly lost access to your doctor?” the notices read. “Can’t get your medications at the pharmacy? Beware! You may have been tricked into signing up for a program that is medically unnecessary for you.”

Contact Us

If you or a loved one has information regarding a whistleblower or qui tam case of false claims for Medicare and Medicaid reimbursement for hospice patients, contact Ingrid M. Evans at Evans Law Firm, Inc. at (415) 441-8669, or TOLL FREE 1-888-80EVANS (888-503-8267) or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. Ingrid also handles other types of whistleblower cases including for bank fraud under The Financial Institutions Reform, Recovery, and Enforcement Act of 1989 (FIRREA/FIAFEA), securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, the Internal Revenue Service Whistleblower Office, the FINRA Whistleblower Office or the California False Claims Act.

[1] You can read Ms. Kofman’s full article here: How Hospice Became a For-Profit Hustle | The New Yorker or an expanded version in ProPublica with links to Ms. Kofman’s research here: How the Hospice Movement Became a For-Profit Hustle — ProPublica.

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