by Ben Vernia | October 16th, 2015
On October 2, the Department of Justice announced that Atlanta-based Guardian Hospice (and related companies) has agreed to pay $3 million to resolve civil charges, originally brought by a whistleblower, that the company submitted claim for hospice care provided to non-terminally ill Medicare patients. According to DOJ’s press release:
Guardian Hospice of Georgia LLC, Guardian Home Care Holdings Inc. and AccentCare Inc. (collectively Guardian) agreed to pay $3 million to resolve allegations that Guardian knowingly submitted false claims to the Medicare program for hospice patients who were not terminally ill, the Department of Justice announced today. Guardian is a for-profit hospice which provides hospice services in Atlanta.
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The Medicare hospice benefit is available for patients who elect palliative treatment (medical care focused on providing patients with relief from pain, symptoms or stress) for a terminal illness and have a life expectancy of six months or less if their illness runs its normal course. Before billing Medicare, a hospice provider is obligated to comply with Medicare requirements and ensure that patients who are foregoing curative care are in need of end of life care.
The government alleged that Guardian submitted or caused the submission of false claims for hospice care for patients who Guardian knew were not terminally ill. Specifically, the United States contended that Guardian’s business practices contributed to its submission of claims for patients who did not have a terminal prognosis of six months or less, including failing to properly train its staff and medical directors on the hospice eligibility criteria, setting aggressive targets to recruit and enroll patients, and failing to properly oversee the Atlanta hospice.
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DOJ announced that the two former Guardian employees who brought the suit will receive a total of $510,000 (a 17% relator’s share).
