by Ben Vernia | September 6th, 2012
On September 6, the Department of Justice announced that it was intervening in a qui tam suit filed in Orlando against a hospice. According to DOJ’s press release:
The government has intervened in a whistleblower lawsuit against Hospice of the Comforter Inc. (HOTCI) alleging false Medicare billings, the Justice Department announced today. HOTCI provides hospice services to patients residing in the vicinity of Orlando, Fla.
The Medicare hospice benefit is available for patients who elect palliative treatment (medical care focused on providing patients with relief from pain and stress) for a terminal illness, and have a life expectancy of six months or less if their disease runs its normal course. When an individual is admitted to a hospice facility, that individual is no longer entitled to receive curative care (services designed to cure his or her illness).
The lawsuit, filed by HOTCI’s former vice-president of finance, Douglas Stone, alleges that HOTCI knowingly submitted false claims to Medicare for hospice care for patients who were not terminally ill. Specifically, the lawsuit contends that HOTCI’s chief executive officer verbally instructed HOTCI employees to admit Medicare recipients for hospice care even where there had not yet been a determination that they were eligible for the hospice benefit. The lawsuit also alleges that, after being notified that it would be audited by its Medicare contractor, HOTCI formed an internal committee to review the eligibility of its Medicare patients and discharged at least 150 patients in 2009-2010 as being ineligible for the Medicare hospice benefit.