The Office of Inspector General identified “reducing waste in . . . hospice care” as one of the “top management challenges” for the 2015 fiscal year. The federal government’s efforts to respond to that challenge are illustrated by several recent developments in False Claims Act (“FCA“) cases brought against hospice care providers. For example, the Robinson-Hill, Betts, and Gooch cases discussed herein underscore the attention given to hospice care providers and their alleged billing and personnel-related practices, and the high monetary settlements that can result from such attention.
Specifically, on October 2, 2015 a hospice provider agreed to a $16,000,000 settlement in exchange for the dismissal with prejudice of FCA, anti-kickback, and other related claims. Robinson-Hill et al. v. Nurses’ Registry and Home Health Corp., Case No. 5:08-cv-00145 (E.D. Ky.) As detailed in the settlement agreement, Robinson-Hill arose out of allegations that the defendant violated the FCA by, among other things: (i) upcoding the severity of patients’ medical conditions; (ii) providing medically unnecessary therapy services; (iii) recertifying patients for services for which those patients were no longer eligible; and (iv) backdating or falsifying patient records. (Case No. 5:08-cv-00145, Dkt. 310-1.)
On October 1, 2015, a collection of hospice care providers resolved an FCA case by way of a $3,000,000 settlement. U.S. ex rel. Betts et al., v. Texas Home Health of America LP et al., Case No. 1:12-cv-00412 (N.D. Ga.) As reported by the Department of Justice, “[t]he government alleged that [the defendant] submitted or caused the submission of false claims for hospice care for patients who [the defendant] knew were not terminally ill.” The government also alleged that the defendant: (i) “fail[ed] to properly train its staff and medical directors on the hospice eligibility criteria”; (ii) “set aggressive targets to recruit and enroll patients”; and (iii) “fail[ed] to properly oversee the Atlanta hospice.”
Finally, on September 24, 2015, an individual associated with a hospice care provider was sued in Mississippi federal court for alleged FCA violations. U.S. v. Gooch, Case No. 4:15-cv-140 (N.D. Miss.). According to the complaint, the defendant was employed as a homemaker/aide for Angelic Hospice and Palliative Care Services and in that role allegedly conspired to submit false claims to Medicare for payments for hospice care that was either (i) not rendered or (ii) medically unnecessary. The defendant also allegedly received certain payments in exchange for her role in the submission of the false claims at issue.