Florida hospice pays $3 million to settle allegations it submitted claims for non-terminally ill patients

by Ben Vernia | November 6th, 2013

On November 5, the Department of Justice announced that an Orlando, Florida hospice, had agreed to settle claims, initially brought by a whistleblower who is a former employee, that it submitted claims for hospice services for patients who were not terminally ill. According to DOJ’s press release:

Hospice of the Comforter Inc. (HOTCI) has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program for hospice services provided to patients who were not eligible for the Medicare hospice benefit, the Justice Department announced today. HOTCI is headquartered in Altamonte Springs, Fla., and provides hospice services to patients residing in Seminole, Osceola and Orange counties in Florida.

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The government alleged that between December 2005 and December 2010, HOTCI engaged in practices that resulted in billing Medicare for patients who were not terminally ill. Specifically, HOTCI allegedly directed its staff to admit all referred patients without regard to whether they were eligible for the Medicare hospice benefit, falsified medical records to make it appear that certain patients were eligible for the benefit when they were not, employed field nurses without hospice training, established procedures to limit physicians’ roles in assessing patients’ terminal status and delayed discharging patients when they became ineligible for the benefit.

DOJ also announced that the hospice had taken on a Corporate Integrity Agreement, and that its former CEO had agreed to a 3-year exclusion:

As part of this settlement, HOTCI has agreed to enter into a Corporate Integrity Agreement with the Inspector General of the Department of Health and Human Services that provides for procedures and reviews to be put in place to promptly detect and prevent future conduct similar to that which gave rise to the settlement. In addition, HOTCI’s former Chief Executive Officer Robert Wilson has agreed to a three-year, voluntary exclusion from Medicare, Medicaid and other federal health care programs.

The government also wrote that the whistleblower’s share of the recovery had not yet been determined.

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