Literature Review

Bereaved families face ‘devastating’ impacts of hospice fraud Hospice News; by Holly Vossel; 7/16/24 Fraudulent activity in the hospice space may be leaving some families without sufficient bereavement support. Fraudulent hospice schemes can take a tremendous toll on families that have lost loved ones who received poor or negligent end-of-life care, according to Cheryl Kraus, director of government affairs and policy at the Hospice & Palliative Care Association of New York State (HPCANYS). ... “It’s tragic if you’re already grieving the loss of a loved one to have your suspicions confirmed that they did not receive the level of care that they were entitled to because of bad actors in the hospice space,” Kraus said. “It just shocks the conscience what these fraudulent hospices are doing to people. It’s going to take a long time to restore not just the individuals’ trust who have experienced this firsthand, but also the public’s.” 

Hospice CARES Act would update medical reviews, seek to reduce audits Hospice News; by Jim Parker; 7/12/24 The forthcoming Hospice Care Accountability, Reform and Enforcement (Hospice CARE) Act from U.S. Rep. Earl Blumenaur (D-Oregon), if enacted, would implement a number of changes to medical review processes. ... Though the bill language is still in development, it will likely contain proposed updates to payment mechanisms for high-acuity palliative services, changes to the per-diem payment process and actions to improve quality and combat fraud. The bill would also implement a temporary, national moratorium on the enrollment of new hospices into Medicare, to help stem the tide of fraudulent activities among recently established providers concentrated primarily in California, Arizona, Texas and Nevada. ... Among the anticipated provisions of the bill would be an item requiring the U.S. Centers for Medicare & Medicaid Services (CMS) to use documentation in a patient’s medical record as supporting material. The documentation would include the reasons that an attending physician certified a patient for hospice and establish a six-month terminal prognosis.

Home health providers to pay $4.5M to resolve alleged false claims act liability for providing kickbacks to assisted living facilities and doctorsDOJ press release; 7/1/24Guardian Health Care Inc., Gem City Home Care LLC and Care Connection of Cincinnati LLC, home health agencies operating in Texas, Ohio and Indiana, along with their owner Evolution Health LLC, have agreed to pay $4,496,330 to resolve allegations that they violated the False Claims Act by knowingly providing illegal kickbacks to assisted living facilities and physicians in exchange for Medicare referrals.

Former Kentucky hospital nurse charged with patient credit card fraud Becker's Hospital Review; by Alan Condon; 7/2/24 A nurse previously employed by Baptist Hospital East in Louisville, Ky., was arrested July 1 for allegedly using patients' stolen credit cards, according to ABC affiliate WHAS. Kentucky State Police charged Lauren Miller with stealing two or more patients' credit cards and fraudulently using those cards, according to the report. Ms. Miller allegedly used the credit cards for purchases totaling more than $1,000 between Nov. 27 and Dec. 7. ... "She is not employed by Baptist Health. In accordance with federal privacy laws, we are unable to share any additional information," a spokesperson for the hospital told Becker's. 

Muncie hospice nurse accused of obtaining narcotics 'by fraud or deceit' The Star Press, Muncie, IN; by Douglas Walker; 7/2/24 A Muncie hospice nurse is accused of ordering prescription pain medication in the names of nursing home residents who then never received the narcotics. Meredith Griffin Briles, 45, is charged in Delaware Circuit Court 5 with obtaining a controlled substance by fraud or deceit, possession of a narcotic drug and failure to make, keep or furnish a record. All three charges are Level 6 felonies carrying up to 30 months in prison.

Hospice care company owner sentenced on health care fraud charges United States Attorney's Office - Western District of Louisiana; Press Release; 6/20/24 United States Attorney Brandon B. Brown announced that Kristal Glover-Wing, 51, formerly a resident of Broussard, Louisiana, and now living in California, has been sentenced for conspiracy to commit health care fraud and three counts of health care fraud. United States District Judge Robert R. Summerhays sentenced Glover-Wing to 72 months in prison, followed by 3 years of supervised release.  She was also ordered to pay $3,675,948.42 in restitution. ... Glover-Wing was the owner of Angel Care Hospice (“Angel Care”), a Louisiana corporation that purported to provide hospice services in Lafayette Parish and other parishes in the Western District of Louisiana. Through evidence presented at trial, jurors learned that from approximately 2009 through 2017, over 24 patients were placed on hospice by Angel Care without meeting the criteria required by Medicare. During the time period that the patients were on hospice and under the care and supervision of Angel Care, none of them had been diagnosed with a terminal condition. In fact, many of the patients themselves, who are still alive and thriving many years later, as well as family members of other patients, testified that they never knew that they had been placed on hospice. 

Chicago laboratory owner charged with defrauding Medicare in $60 million COVID-19 test kit scheme JD Supra; by Randall Brater, M.H. Joshua Chiu, Michael Dearington, Rebecca Foreman, Nadia Patel, D. Jacques Smith, Hillary Stemple; 6/17/24 The Chicago-based owner of two laboratories, Zoom Labs Inc. and Western Labs Co., has been charged with health care fraud and money laundering in connection with more than $60 million in Medicare claims for over-the-counter (OTC) COVID-19 test kits, including tests delivered to thousands of deceased beneficiaries. Federal prosecutors began investigating Medicare claims from Syed S. Ahmed’s two laboratories after noticing a “massive spike” in the laboratories’ claims in 2023, which coincided with Ahmed assuming control of Zoom [Labs]. ... Ahmed is charged with health care fraud under 18 U.S.C. § 1347 and money laundering under 18 U.S.C. §§ 1956 and 1957. 

Home health agency racked up $8.5 million through fraudulent claims, hired employees with criminal historyHome Heath Care News; by Andrew Donlan; 6/13/24The former owner of a home-based care company – based in the Cincinnati area – has been found guilty of fraudulently billing more than $8.5 million from Medicare, Medicaid and Veterans Affairs (VA) over a six-year period. From 2015 to 2021, Sharon Romaine Ward submitted at least 92,770 claims on behalf of Halo Home Healthcare to Medicaid, and received $8.4 million between 2016 and 2021. She also admitted that she concealed her ownership of that company because of a prior felony conviction.

U.S. Rep. Beth Van Duyne: Crack down on hospice fraud Hospice News; by Jim Parker; 6/12/24 Rep. Beth Van Duyne, (R-Texas) has emerged as one of Washington’s most vocal advocates for hospice providers in Congress. ... Van Duyne was among a group of lawmakers that wrote to CMS Administrator Chiquita Brooks LaSure last month requesting updates on the agency’s battles against fraudulent providers, as well as a U.S. Government Accountability Office (GAO) report on quality issues in the hospice space. Hospice News spoke with Rep. Van Duyne in Washington D.C. on congressional efforts to root out fraud and where they should go next. 

How fraudulent hospices evade regulators Hospice News; by Jim Parker; 6/5/24A slew of fraudulent hospices in California are dodging consequences by shuffling patients around between provider numbers. That’s according to multiple sources who spoke with Hospice News, expressing their concerns about patterns of fraud continuing even as government regulators crack down on the sector. Since 2021, numerous media and government reports have emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. Despite the best efforts of regulators and law enforcement, hospice leaders are concerned that many bad actors are slipping through the cracks. 

Reap what you sowFraud of the Day; by Larry Benson; 6/4/24Newly released Federal Trade Commission data show that consumers reported losing more than $10 billion to fraud in 2023, marking the first time that fraud losses have reached that benchmark. This marks a 14% increase over reported losses in 2022. The short of this report is that there is more opportunity in fraud than ever before. And fraudsters don’t care who they are scheming from. Including the dying. Shiva Akula owned and oversaw the day-to-day operations of Canon Healthcare, LLC, a hospice facility with offices in Louisiana and Mississippi. ... Between January 2013 and December 2019, Akula billed Medicare approximately $84 million in fraudulent claims. He was paid approximately $42 million relating to these fraudulent claims. And leaving the dying to just do that. Die without the extra care he profited from. ... [Akula was sentenced to serve 20 years in prison and to repay $42 million in fraudulent Medicare billing claims.]

Owner of home health services agency and parent of disabled child arrested for Medicaid provider fraudFL Office of the Attorney General; 5/15/24Tallahassee, FL - Attorney General Ashley Moody’s Medicaid Fraud Control Unit announced the arrest of the owner of a home health services agency and a parent of a disabled child for Medicaid provider fraud. Latrena Marie Thomas is the owner of A River’s Journey, a home health care agency with residential home care facilities located in Yulee and Jacksonville. Thomas is accused of hiring non-licensed individuals to provide hands-on personal care services to Medicaid recipients. In addition, Thomas paid Donald Ray Adams II, a parent of a disabled Medicaid recipient, to provide medically licensed care for his own child. In total, Thomas fraudulently billed Medicaid claims for 30 distinct medically needy Medicaid recipients, which caused a total loss of more than $1.6 million.

New DOJ task force to tackle competition-related concerns in healthcare McKnights Senior Living; by Kathleen Steele Gaivin; 5/13/24 The Justice Department said its Antitrust Division’s new Task Force on Health Care Monopolies and Collusion will consider “widespread competition concerns shared by patients, healthcare professionals, businesses and entrepreneurs, including issues regarding payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, healthcare IT services, access to and misuse of healthcare data and more.” The group’s mandate is to facilitate policy advocacy, investigations and, where warranted, civil and criminal enforcement in healthcare markets.