Literature Review

Jury convicts home health agency executive of fixing wages and fraudulently concealing criminal investigation U.S. Department of Justice - Office of Public Affairs; Press Release; 4/14/25 A federal jury convicted a Nevada man today for participating in a three-year conspiracy to fix the wages for home healthcare nurses in Las Vegas and for fraudulently failing to disclose the criminal antitrust investigation during the sale of his home healthcare staffing company.  According to court documents and evidence presented at trial, Eduardo “Eddie” Lopez of Las Vegas, Nevada conspired to artificially cap the wages of home healthcare nurses in the Las Vegas area between March 2016 and May 2019. The three-year conspiracy affected the wages of hundreds of Las Vegas registered nurses and licensed practical nurses who provide care to patients in their homes. During the pendency of the government’s investigation, Lopez then sold his home healthcare staffing company for over $10 million while fraudulently concealing the government’s criminal investigation from the buyer.  

Tennessee physician sentenced for $41M fraud scheme Becker's ASC Review; by Patsy Newitt; 4/15/25An Ashland City, Tenn.-based physician was sentenced to three years in prison for his role in a $41 million healthcare fraud scheme, according to an April 14 news release from the Justice Department.  What happened? 

Fired health workers were told to contact an employee. She’s dead. The Washington Post; by Lauren Weber; 4/3/25 Some government health employees who were laid off Tuesday were told to contact Anita Pinder with discrimination complaints. But Pinder, who was the director at the Office of Equal Opportunity and Civil Rights at the Centers for Medicare and Medicaid Services, died last year. [Continue reading ...]Editor's note: Perhaps, is this its own example of fraud (incorrect contact for such an important initiative) and abuse (of the fired employees' rights, and of Anita Pinder's memory, family, and colleagues)?

Fraud alert: HHS-OIG telephone numbers used in scam The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG); 4/3/25 The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) confirmed that official HHS-OIG telephone numbers are being used as part of a spoofing scam targeting individuals throughout the country. These scammers represent themselves as HHS-OIG employees and can alter the appearance of the caller ID to make it seem as if the call is coming from HHS OIG phone numbers found on its public website. The perpetrator may use various tactics to obtain or verify the victim's personal information, which can then be used to steal money from an individual's bank account or for other fraudulent activity. We encourage the public to remain vigilant, protect their personal information, and guard against providing personal information during calls that purport to be from HHS-OIG telephone numbers. We also remind the public that it is still safe to call into the HHS-OIG Hotline to report fraud. We particularly encourage those who believe they may have been a victim of the telephone spoofing scam to report that information to us through the HHS-OIG Hotline 1-800-HHS-TIPS (1-800-447-8477) or online. 

Walgreens settles Illinois Medicaid fraud lawsuit for $5M Modern Healthcare; by Katherine Davis; 3/25/25 Walgreens Boots Alliance will pay $5 million to settle allegations that it violated U.S. and Illinois false claims statutes by improperly billing Medicaid and Medicare. The settlement, disclosed in court filings [3/24], marks the end of the dispute, which began 11 years ago when two whistleblowers claimed Walgreens’ practices violated statutes. ... The settlement, disclosed in court filings yesterday, marks the end of the dispute, which began 11 years ago when two whistleblowers claimed Walgreens’ practices violated statutes. ... The settlement funds will be divided among the U.S. government, the state of Illinois and the whistleblowers, according to court filings. All parties also filed a joint stipulation of dismissal yesterday. Walgreens declined to comment. [Continue reading; access to the full article may be limited to subscription ...]

AGG, New Day’s Bill Dombi: Hospices’ ‘vibrant evolutionary path’ spurs legal growing pains  Hospice News; by Holly Vossel; 3/26/25 Today’s hospice landscape is reaching a pivotal point of evolutionary growth that has come with increased oversight as regulators seek to curb fraudulent activity in the space, according to Bill Dombi, senior counsel for the law firm Arnall Golden Gregory (AGG). ... He previously served as president of the National Association for Home Care & Hospice (NAHC) for 38 years prior to its affiliation with the National Hospice and Palliative Care Organization (NHPCO) in 2023 and was heavily involved in the establishment of the Medicare Hospice Benefit. ... [Dombi:] "... Hospice has been a very vibrant part of the health care world for quite a while now, but I think its energy levels are at an all-time high right now. And that’s energy levels in terms of not just public awareness and utilization of the services, but also the gained respect of recognizing that hospice is not a cottage industry anymore. Some people might label it as growing pains. I call it more of an evolution that naturally seems to occur in any field and in any organization."  [Continue reading ...]

Medicare and 24-hour in-home hospice care​: Is it covered?Healthline; Medically reviewed by Shilpa Amin, MD, CAQ, FAAFP and written by Mandy French; 3/25/25... Medicare offers hospice coverage for beneficiaries. However, there are certain eligibilities and guidelines that they must meet. ...

National Alliance’s Scott Levy: Hospices need ‘regulatory relief’ to protect ‘sacred benefit’ Hospice News; by Holly Vossel; 3/21/25 The hospice industry is undergoing a transformative period of rising demand and regulatory changes. Providers of all sizes and types are facing mounting operational challenges and financial strains with limited recourse to voice their collective concerns to legislators. This is according to Scott Levy, chief government affairs officer at National Alliance for Care at Home (the Alliance). Levy stepped into the role earlier this year after holding a similar position at Amedisys. He has been involved in government relations, public policy, advocacy and law for more than 20 years. Levy recently sat down with Hospice News to discuss the array of regulatory and legislative evolutions on the horizon in hospice care delivery.  .[Continue reading ...]

El Paso doctor pays close to $500K to settle allegations of hospice healthcare fraud CBS 4 News, El Paso, TX; by David Ibave; 3/10/25 A doctor in El Paso agreed to pay almost half a million dollars on Monday to settle allegations that he was paid off by a hospice center to commit healthcare fraud back in 2021. According to the U.S. Department of Justice, John Patterson M.D. has agreed to pay the United States $468,626 to resolve allegations that he received kickback payments from Nursemind Home Care Inc. to certify patients for hospice care when they were not eligible for these services, submitting false claims to federal healthcare programs.

Amid huge growth in Southern Nevada’s hospice industry, lawmaker pushes for more oversight The Nevada Independent; by Tabitha Mueller; 3/5/25 The number of licensed hospice providers in Southern Nevada jumped by more than 350 percent since 2020 — a proliferation combined with minimal industry regulation that health care experts warn harms patients and leads to fraud. To address the issue, Assm. Rebecca Edgeworth (R-Las Vegas) is sponsoring AB161, which is scheduled for a hearing Wednesday. The measure, Edgeworth said, is a way to “raise the bar” for hospice providers and protect patients. “In the last few years, there has been this horrendous influx of charlatans and flimflam artists,” Edgeworth told The Nevada Independent.

Hospice Insights Podcast - Controlling the narrative: A new tactic for auditors and ALJs JD Supra; by Bryan Nowicki and Meg Pekarske; 2/19/25 Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician narrative. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss a new twist on these kinds of denials, and how hospices can strengthen their documentation to try to avoid them.

Saad Healthcare agrees to pay $3M to settle False Claims Act allegations that it billed Medicare for ineligible hospice patientsU.S. Department of Justice - Office of Public Affairs; Press Release; 2/21/25Saad Enterprises Inc., doing business as Saad Healthcare, has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by knowingly submitting false claims for the care of hospice patients in Alabama who were ineligible for the Medicare hospice benefit because they were not terminally ill. ... The settlement resolves allegations that between 2013 and 2020 Saad submitted, or caused the submission of, false claims to Medicare for 21 patients who did not meet the eligibility requirements for the Medicare hospice benefit as defined by statute and regulation, despite Saad knowing the patients were ineligible for the Medicare hospice benefit.

UnitedHealth drops dismissal bid in US suit over Amedisys deal Bloomberg Law; by Justin Wise; 2/6/25 (additional subscription may be required)UnitedHealth Group Inc. is withdrawing its motion to dismiss the Justice Department’s lawsuit seeking to block its $3.3 billion acquisition of home-health and hospice services provider Amedisys Inc. and planning to fight the case at trial. In a Wednesday [2/5/25] filing in the US District Court for the District of Maryland, UnitedHealth and Amedisys said that new information provided by the Justice Department eliminated the basis for its request to toss the case at a preliminary stage. The firms previously argued the DOJ was withholding key geographic market information integral to its claim that the tie-up would stifle competition ...