Literature Review

Southern California doctor sentenced in $2.8 million hospice fraud schemeLos Angeles Daily News; by Sydney Barragan; 8/27/24A Southern California doctor was sentenced Tuesday to 37 months in prison for his role in a $2.8 million fraud scheme in which Medicare was billed for unneeded services, the U.S. Department of Justice announced. John Thropay, 75, of Arcadia was the medical director for several hospice companies, including Blue Sky Hospice Inc. in Van Nuys. From October 2014 to March 2016, Thropay certified terminal illnesses that patients did not have in order to bill Medicare for hospice services, officials said. According to the indictment, the owners of Blue Sky paid recruiters illegal kickbacks in exchange for referring “beneficiaries,” or patients. These recruiters paid the patients approximately $300 to $400 of the kickbacks for every month they remained on hospice care with Blue Sky. 

False Claims Act decisions to know from Q2 2024 JD Supra; by Bass, Berry & Sis PLC; 8/22/24 In case you missed it, this post recaps some key False Claims Act (FCA) decisions and case updates from the second quarter of this year. Courts weighed in on the FCA’s anti-retaliation provision, its first-to-file bar, and issues around judgments and awards. ... In U.S. ex rel. Rosales v. Amedisys, Inc., the relator alleged that Amedisys, a hospice operator, falsely certified patients as terminally ill and submitted claims for reimbursement to Medicare and North Carolina Medicaid for patients who were not properly eligible for hospice care. Amedisys filed a motion to dismiss Rosales’ Amended Complaint for lack of subject-matter jurisdiction, ...

Fraudulent hospices reportedly target homeless people, methadone patients to pad census Hospice News; by Jim Parker; 8/23/24 Fraudulent hospices in California reportedly have been targeting homeless people and methadone patients, promising them a steady supply of opioids in exchange for enrolling in hospice. Three hospice leaders came forward to Hospice News to report these practices. According to their reports, unscrupulous providers have canvassed both homeless encampments and methadone clinics seeking to sign up patients who are not terminally ill. In many cases, the sources said, these operators offer patients free access to board-and-care facilities and a daily supply of morphine. Another frequent practice among these hospices is to offer patients cash or other items in addition to drugs, they said. “This conduct raises serious fraud concerns on kickbacks or gifts to beneficiaries who do not appear to qualify for hospice,” Bill Dombi, president of the National Association for Home Care & Hospice (NAHC), told Hospice News. “More importantly, this conduct is predatory, taking advantage of individuals in addiction. Jail time is not enough punishment for the harm that such conduct creates.”Editor's Note: This is abhorrable. Click on the title's link to read more. While John Oliver's "Last Week Tonight" episode on 8/18/24 gained criticism from many hospice leaders, these fraudulent unethical behaviors (and others') lay the groundwork for such dire distrust from the public. These organizations' behaviors must be stopped. These organizations must be held accountable.

Nationwide home healthcare and hospice provider to pay $3.85M to resolve False Claims Act allegationsDepartment of Justice press release; 8/20/24Intrepid U.S.A. Inc., headquartered in Dallas, and various wholly-owned subsidiaries (Intrepid) have agreed to pay $3,850,000 to resolve allegations that Intrepid violated the False Claims Act in connection with two lines of its business: first, that Intrepid knowingly submitted claims to Medicare for home healthcare services for patients who did not qualify for the Medicare home healthcare benefit or where services otherwise did not qualify for Medicare reimbursement; and second, that Intrepid knowingly submitted claims to Medicare for patients who did not qualify for the hospice benefit. The settlement is based on Intrepid’s ability to pay.

John Oliver on US for-profit hospice care: ‘too important to just hope the free market fixes it' The Guardian; by Adrian Horton; 8/19/24 On the latest Last Week Tonight, John Oliver delved into the many issues with hospice care in the US. Doing so is “an almost offensive parody of this show”, he acknowledged. “If somebody else did that, it would genuinely be hurtful. But I promise this is worth talking about.” There are “lots of dedicated people work with hospices, providing huge relief for dying patients and their families, particularly those who want to remain at home”, such as the 1.8 million Americans who received end-of-life care at home last year. But like anything, hospice is subject to fraud, mismanagement and abuse. One government report estimated that hospice’s inappropriate billing costs Medicare hundreds of millions per year. ... “Hospice care, when done well, is hugely beneficial to those that are dying and their families. It is too important to just hope the free market fixes it,” Oliver concluded. “This industry badly needs reform. That’s clear.” [Click on links below for hospice responses to this "Hospice" episode of Last Week Tonight.] 

Humana will pay $90 million in Medicare drug fraud settlement Bloomberg Law; by Daniel Seiden; 8/16/24 Humana Inc. agreed to pay $90 million to the federal government to settle a whistleblower’s False Claims Act suit alleging that the company submitted fraudulent bids for Medicare Part D prescription drug contracts. Whistleblower Steven Scott alleged that, since 2011, Humana began offering its Medicare Part D prescription drug plan, known as the basic Walmart Plan, and “knowingly provided benefits under that plan that have been significantly less valuable than Humana promised in its bids,” according to Scott’s suit filed in 2016 in the US District Court for the Central District of California. ... This suit was among several in 2016, including suits against Humana, United Health, Cigna Corp., and Optum RX Inc., accusing health insurers of secretly overcharging for prescription drugs.

Stay ahead of Medicare fraudsters ... Watch out for Medicare fraudsters The Times of Noblesville, Indiana; Information provided by the U.S. Department of HEalth & Human Services 8/16/24 (Family Features) ... Watch Out for Medicare Hospice Fraud: 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. Remember this advice to avoid hospice scams: [practical tips for the public] ... Report Medicare Fraud ...Editor's Note: This information for the public--provided by the U.S. Department of Health & Human Services--provides an important resource for your community outreach, marketing, and admissions employees.

No prison for nursing home owner who botched Hurricane Ida evacuation, leading to 7 resident deathsMcKnight's Long-Term Care News; by Josh Henreckson;7/23/24Bob Dean has been sentenced to three years of probation and must pay more than $1.3 million in restitution and penalties for his role in the disastrous emergency evacuation of nearly 850 residents from his seven Louisiana nursing homes during Hurricane Ida. The 2021 emergency evacuation to a warehouse Dean owned near New Orleans left the residents of his nursing homes in a state of overcrowding and neglect. Seven died within days of the storm — with hundreds more rescued by state officials. Dean pleaded no contest to 15 state criminal charges, including multiple counts each of cruelty to the infirmed, obstruction of justice and Medicaid fraud.

‘Sharpen your game:’ Dombi tells hospices to step up in face of stricter government oversight McKnight's Home Care; by Adam Healy; 7/22/24The Centers for Medicare & Medicaid Services has hospice on its radar, and providers’ best safeguard against unwanted attention is to take oversight measures into their own hands, according to William Dombi, president of the National Association for Home Care & Hospice. “Sharpen your game before somebody knocks on your door,” Dombi said Monday during a press conference at the 2024 NAHC Financial Management Conference in Las Vegas. He recommended that hospice providers look internally to identify problems that could raise regulators’ alarms. An independent audit, he noted, could be helpful for spotting potential noncompliance... He later noted, “Hospices believe they’re compliant when they’re probably not.”

Youngstown hospice nurses help alert feds on alleged insurance fraud; company pays settlementMahoning Matters; by Erina Anwar; 7/26/24 ... The U.S. Department of Justice announced on July 17 that federal prosecutors had settled with Gentiva, formerly known as Kindred at Home, after more than 20 whistleblowers — including two hospice nurses from Youngstown, Ohio — alerted the government for alleged fraud. The [Youngstown] nurses, Jason Medved and Anthony Donnadio, will receive a portion of the payout for reporting the fraud at a Youngstown hospice via a lawsuit they filed in 2023 under the federal False Claims Act (FCA). “As registered nurses, Jason and Anthony owed a duty to their hospice patients first and foremost,” Janel Quinn, a principal of The Employment Law Group said. “They were advocates for ethical medicine, even when it wasn’t easy. This settlement is a fitting recognition of their professionalism and their bravery.”

Local whistleblowers help in federal hospice investigation CBS WKBN-27, Austintown, OH; by Patty Coller; 7/22/24 The parent company that operates a hospice provider in Austintown has agreed to a settlement in a federal lawsuit alleging that the local location, along with others in the southern part of the country, defrauded the government, according to federal prosecutors. Gentiva, formerly known as Kindred at Home, has agreed to pay $19 million to resolve allegations that it and other entities of Gentiva knowingly submitted, or caused to be submitted, false claims for hospice services provided to patients who were ineligible for hospice benefits under Medicare and other federal health care programs because the patients were not terminally ill, according to Department of Justice. ... The Employment Law Group said in a news release that there were 20 whistleblowers in the case, including two from the Youngstown area involving SouthernCare, who helped to recover about $2.13 million in alleged fraudulent billing.

‘Bad apples in a barrel’: How fraudsters in home health care impact the entire space Home Health Care News; by Joyce Famakinwa; 7/19/24 The home health industry has its very own boogeyman--the bad actor. However, there's a difference between providers that had made errors in claims ... [Subscription required to continue reading]

Kindred and related entities agree to pay $19.428M to settle federal and state false claims act lawsuits alleging ineligible claims for hospice patients U.S. Department of Justice - Office of Public Affairs; Press Release; 7/17/24 Gentiva, successor to Kindred at Home, has agreed to pay $19.428 million to resolve allegations that Kindred at Home and related entities (Kindred) knowingly submitted false claims and knowingly retained overpayments for hospice services provided to patients who were ineligible to receive hospice benefits under various federal health care programs. Gentiva’s hospice operations, headquartered in Atlanta, include entities that previously operated Kindred at Home hospice locations under the names Avalon, Kindred, SouthernCare and SouthernCare New Beacon. [Click on the title's link to continue reading.]