Literature Review

CMS ramps up efforts to root out ‘door knocker’ hospice schemes Hospice News; by Holly Vossel; 11/15/24 The U.S. Centers for Medicare & Medicaid Services (CMS) recently elaborated on its plans to expand public education campaigns designed to help protect hospice beneficiaries from fraudulent actors in the space. ... “One of the areas we’re working with right now is to enhance education — beneficiary education specifically,” Pryor said during a recent CMS webinar. “We have hospice beneficiaries who are unfortunately fraudulently signed up for the benefit in these kind of, what we call, ‘door knocker scams.’” The scams include bad actors reaching out to beneficiaries with offers of free goods and services, such as groceries, TVs, reclining chairs and furniture, Pryor explained. The fraudulent marketing tactics are posing significant complications for Medicare beneficiaries, he said.

Homecare owner allegedly withholds $86k in wages HomeCare, Indianapolis, IN; 11/11/24 The U.S. Department of Labor (DOL) has alleged that home health care company owner Hahn March violated federal wage laws and withheld $86,000 in wages by using improper pay practices at her two Indianapolis, Indiana, companies: Signal Health Group Inc. and SHG Employee Leasing Company. In 2018, federal investigators cited March for not paying overtime wages to employees at her then-owned company, Aging and Disabled Home Healthcare. ... The complaint was filed following an investigation by the DOL Wage and Hour Division, which discovered March and Nancy Stanley, the chief financial officer of both companies, used an artificial regular rate pay scheme to lower hourly pay rates and, in turn, shortchanged employees $86,427 in overtime wages. ... The DOL is seeking $172,854—including $86,427 in back wages and an equal amount in liquated damages—for 43 current and former employees. ... “Employees who work in home health care—one of our nation’s lowest-paying professions—provide necessary daily and hospice care that allow individuals to remain in their homes and aid them in navigating their basic needs, providing dignity and comfort to clients and their families,” said Aaron Loomis, Wage and Hour Division district director.

Arrest warrant issued gor a California hospice care executive PRLog - Press Release Distribution, Los Angeles, CA; 11/8/24 The Superior Court of California in Los Angeles has issued a Bench Warrant for the arrest of Darline Singh, owner of Zola Hospice LLC, and associated with numerous other hospice companies throughout the state. Singh failed to appear in court on 9/12/2024 and on 10/24/2024 for a judgment debtor exam stemming from a $15MM judgment against Singh, Zola Hospice LLC, and E&E Hospice, LLC. Darline Singh's resume indicates she has a degree in Chemical engineering from UC Davis, AI Machine learning at MIT, as well as Harvard University. Her work experience highlights consulting and executive roles at Brookdale Senior Living, ACE Hospice, Suncrest Healthcare, Vitas Healthcare, Kindred Healthcare, and Bridge Hospice. In March of 2022 Acting California State Auditor, Michael S. Tilden, reported in a letter to the Governor, "my office conducted an audit of the State's licensure and oversight of hospice agencies and found that the State's weak controls have created the opportunity for large-scale fraud and abuse. We identified numerous indicators of such fraud and abuse by hospice agencies."

Healthcare billing fraud: 10 recent casesBecker's Hospital Review; by Andrew Cass; 10/28/24

What hospices need to know about whistleblower lawsuits Hospice News; by Holly Vossel; 10/22/24 Hospices need to understand the range of risks involved in qui tam cases and how best to navigate whistleblower concerns amid an evolving regulatory landscape. Qui tam actions occur when a whistleblower, called a “relator” by the courts, files a False Claims Act suit on behalf of the government. The relator has the potential to receive a portion of any funds recovered by the government via the lawsuit, with amounts typically ranging from 15% to 25%. A federal judge recently found the qui tam clause unconstitutional, ruling that the relator’s role in sparking enforcement actions effectively makes them an executive branch officer appointed without due process.

Gentiva reaches $19.4 million False Claims Act Settlement Policy & Medicine; by Thomas Sullivan; 10/15/24 Gentiva – formerly known as Kindred at Home – reached a $19.4 million settlement with the United States, resolving allegations that it violated the False Claims Act by holding on to overpayments for hospice services provided to patients who were ineligible to receive hospice benefits under various federal health care programs. Kindred is made up of entities that were previously part of an enterprise that did business through various subsidiaries as Kindred at Home. Kindred provided health care services, including hospice services, using various business names during the time periods relevant to the settlement. The settlement resolves allegations brought by the United States and the State of Tennessee against certain Kindred entities alleging that from 2010 until February 2020, the entities knowingly submitted (or caused to be submitted) false claims for hospice services to hospice patients in Tennessee and other states who were ineligible for Medicare or Medicaid hospice benefit because they were not terminally ill. The settlement further resolved allegations that the defendants improperly concealed or otherwise avoided the obligation to repay the hospice claims at issue. The settlement also resolves allegations that SouthernCare New Beacon – a subsidiary – allegedly violated the Anti-Kickback Statute by willfully paying remuneration to a consulting physician to induce Medicare beneficiary hospice referrals.

Two Los Angeles-area residents arrested on indictment alleging scheme to fraudulently obtain and launder Medicare proceedsUnited States Attorney's Office - Central District of California; Press Release; 10/9/24 A Los Angeles woman and a San Fernando Valley man were arrested today on a 24-count federal grand jury indictment alleging a scheme to defraud Medicare out of more than $54 million via hospice and diagnostic testing services that were never provided and then laundered their illicit proceeds, including by buying millions of dollars’ worth of gold bars and coins. Sophia Shaklian, 36, of the Larchmont area of Los Angeles, and Alex Alexsanian, 47, of Burbank, were arrested early this morning. They are scheduled to be arraigned this afternoon in United States District Court in downtown Los Angeles. ... According to the indictment that a federal grand jury returned on October 2, Shaklian, often using aliases, managed and submitted claims for seven health care providers enrolled with Medicare and located in Los Angeles County. These businesses included a hospice company she owned – the Pasadena-based Chateau d’Lumina Hospice and Palliative Care – and several diagnostic testing companies: Saint Gorge Radiology in Sylmar; Hope Diagnostics in North Hollywood; Direct Imaging & Diagnostics and Lab One – both located in Hollywood; and Labtech and Lifescan Diagnostics in Claremont.

Court rules False Claims Act Provisions unconstitutional, with implications for hospice cases Hospice News; by Jim Parker; 10/7/24 A federal judge has struck down the whistleblower provisions of the False Claims Act, with broad implications for hospice and other health care enforcement actions. The ruling centers on the law’s qui tam clauses, which the court found unconstitutional. In a qui tam action, a whistleblower, called a “relator” by the courts, files a False Claims Act suit on behalf of the government and possibly receives a portion of any funds recovered by the government via the lawsuit, typically ranging from 15% to 25%. The overwhelming majority of False Claims Act cases involve qui tam whistleblowers. In Fiscal Year 2023, for example, these cases recovered $2.3 billion of the total $2.68 billion recouped by the government in FCA settlements and judgements, according to a report from the law firm Polsinelli. ... FCA cases have been rampant in the hospice space during the last several years. Many of the major cases and settlements that have occurred during that time have been qui tam actions, including two major actions this year. ...

Community Healthcare CEO: Enact moratorium to combat hospice fraud Hospice News; by Jim Parker; 10/4/24 Community Healthcare of Texas CEO Viki Jingle has kept her finger on the pulse of potential hospice fraud occurring in her home state. She and her colleagues recently brought a range of concerns to a discussion with Rep. Beth Van Duyne (R-Texas) in Community Healthcare’s second meeting with the Congress member. Van Duyne has been among the legislators who have been most vocal about hospice fraud since the problem began to emerge. Among the most important issues under discussion is a rash of newly licensed hospice operators in multiple states that some have associated with suspicious or unethical practices. The issue first gained attention in 2022 in California, but stakeholders have also raised concerns about providers in Nevada, Arizona and Texas. [Click on the title's link to continue reading.]

CMS finalizes rule to curtail major DME fraud concernsMcKnight's Home Care; by Adam Healy; 9/26/24The Centers for Medicare & Medicaid Services finalized a rule this week that will help it better track anomalous and highly suspicious billing activity for durable medical equipment. The rule allows CMS to more closely monitor two Healthcare Common Procedure Coding System (HCPCS) billing codes for urinary catheters: A4352, an intermittent urinary catheter with a curved tip, and A4353, an intermittent urinary catheter with insertion supplies. These two billing codes were behind what may be the largest case of Medicare fraud in the program’s history. In February, the National Association of ACOs (NAACOS) uncovered evidence that fraudsters had used the two codes to loot as much as $3 billion or more from government health programs.

‘Think like a reviewer’: How hospices can use communication, documentation to boost quality McKnights Home Care; by Adam Healy; 9/24/24 Regulators are tightening their scrutiny of the hospice industry, so providers must prioritize the documentation and communication practices that help them obtain higher quality scores. That’s according to hospice industry experts who spoke during an educational session at the National Hospice and Palliative Care Organization’s annual meeting in Denver. “They’re looking closely at the hospice industry,” Angela Huff, senior managing consultant at Forvis Mazars, said last week during the conference. “They have increasing concerns about fraud, waste and abuse in this space. … Don’t think this is going to stop.” ... A key part of hospice quality assurance is communication, Gallarneau said. Providers should support open, friendly channels of communication. This helps staff and clients feel comfortable raising concerns, making quality issues easier to tackle quickly and effectively. Also, prioritizing accuracy in documentation will help providers stay ready for any surveys or audits, Gallarneau noted. Hospices should ensure patient consent and election of benefit forms are properly filled out, signed and dated, and staff should all be trained to do so accordingly. 

Telehealth bill for Medicare approved by House Panel Retirement Daily; by Retirement Daily; 9/21/24 House Ways and Means Committee on Sept. 18, 2024, passed the Preserving Telehealth, Hospital, and Ambulance Access Act by a vote of 41-0 after lawmakers raised concerns about the need for more guardrails and hospice recertification. The move sets up the legislation for passage by the full House later this year. The markup included objections by Democrats and Republicans to the high cost durable medical equipment and clinical diagnostics guardrails proposed in the bill, saying the provisions merely restate existing authorities of the Center for Medicare and Medicaid Services. The bill requires reports on DME and clinical diagnostics fraud which some lawmakers think have already been established and don’t need further study. Many lawmakers likewise expressed concern about the extension of hospice recertification via telehealth. Some lawmakers raised concern about fraud in the hospice program, which they say the telehealth requirement could let fester.

Hospice fraud prevention toolkitCMS press release; 9/24People with Medicare should beware of scammers offering older Americans in-home perks, like free cooking, cleaning and home health services, while they are unknowingly being signed up for hospice services. The scammers then unlawfully bill Medicare for these services in your name. Criminals are using every avenue they can to sign people up including door-to-door visits, false advertising, phone, text and email. Hospice care is for people who are terminally ill and only the patient and doctor can make this serious decision about end-of-life care. This toolkit includes social media posts and a drop-in article to help educate beneficiaries and their loved ones on how to protect themselves against Medicare Hospice fraud.Publisher's note: Also see resources posted on the CMS Senior Medicare Patrol Hospice Fraud website.