Literature Review

Medicaid Fraud Control Units Fiscal Year 2023 Annual ReportU.S. Department of Health and Human Services, Office of Inspector General; 3/14/2024Medicaid Fraud Control Units (MFCUs or Units) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. [This 32 page, downloadable document includes:]

A whistleblower lawsuit cost ChristianaCare $47M. Why are whistleblower cases increasing? Delaware Online, by Esteban Parra and Xerxes Wilson; 3/4/24A former medical director specializing in neurosurgery at southern Delaware’s largest health care provider claims in a lawsuit that Bayhealth Medical Center misclassified “brain-dead” patients in order to overbill for services. ... [The whistleblower reported that] hospital officials discussed a "new hospital initiative" in which suspected "brain-dead" patients would be discharged and admitted to hospice before any declaration of brain death, according to the lawsuit. The scheme allowed for prolonged billing where previous billing ended with the patient’s death, the complaint states. [Please refer to the article for details.]

False Claims Act - 2023 Year in ReviewJD Supra; by William Athanas, A. Lee Bentley III, Gene Besen, Ryan Dean, Jonathan Ferry, Daniel Fortune, Giovanni Giarratana, Ty Howard, Elisha Kobre, Anna Lashley, Gregory Marshall, Lyndsay Medlin, Stephen Moulton, Ocasha Musah, Scarlett Singleton Nokes, Cara Rice, Brad Robertson, Tara Sarosiek, Jack Selden, Erin Sullivan, Courtlyn Ward, Virginia Wright; 2/28/24As we do every year, this issue revisits the key cases and other developments from the year gone by. And by most metrics, 2023 was a notable year for the False Claims Act (FCA).

How one hospice owner got convicted of healthcare fraud and how you can avoid that fateHospice Insights: The Law and Beyond, by Husch Blackwell; 2/21/24The owner of a Louisiana hospice was indicted and then convicted of healthcare fraud. How did that happen? In this [podcast] episode, Husch Blackwell's Meg Pekarske and Jonathan Porter talk about how a routine audit led to a whistleblower complaint by a hospice employee, which then led to the hospice owner’s criminal conviction following trial in November 2023. Most importantly, the pair discuss how other hospices can avoid that fate.

Doctor convicted of $2.8M hospice Medicare fraud schemeHomeCare; 2/20/24A federal jury convicted a California man for his role in a scheme to defraud Medicare by billing $2.8 million for hospice services that patients did not need. From October 2014 to March 2016, [John] Thropay fraudulently certified Medicare patients ... as having terminal illnesses that the patients did not have ... [in order to] bill Medicare for hospice services. In 2015, Thropay was listed as an attending provider for more hospice claims paid by Medicare than any other provider in the nation.

California Hospice Network: State falls short in curbing potential malfeasanceHospice News, by Jim Parker; 2/8/24The continued licensing of new hospices in California despite a moratorium is “deeply disturbing and frustrating,” the California Hospice Network (CHN) indicated in a statement. The practice is undermining efforts to combat hospice fraud, which has been rampant in California according to media and state government investigations. In 2021, the state enacted two hospice reform laws  — Senate Bill 664 and Assembly Bill 1280 — designed to strengthen oversight, including a moratorium on new licenses and an extensive audit of California’s licensing and oversight processes.

Hospice fraud back in the spotlight, with new data also raising questions about home health careHome Health Care News, by Robert Holly; 1/30/24The number of hospice providers enrolled in the Medicare program in four states has skyrocketed over the past few years. The jaw-dropping spike, in turn, has triggered increased oversight efforts – some of which may not be having the desired effect. A similar trend could be happening in home health care in one major county, U.S. Centers for Medicare & Medicaid Services (CMS) data suggests. In hospice, the surge of new providers and potentially fraudulent activities has been concentrated in Arizona, California, Nevada and Texas. In home health care, it’s Los Angeles County.

Washington State reaches a nearly $150 million settlement with Johnson & Johnson over opioid crisisAP, by Manuel Valdes and Hallie Golden; 1/24/24The Washington state attorney general announced a $149.5 million settlement Wednesday with drugmaker Johnson & Johnson, more than four years after the state sued the company over its role in the opioid addiction crisis. “They knew what the harm was. They did it anyway,” Attorney General Bob Ferguson told reporters Wednesday. 

US Senate launches investigation of assisted living after lay media reports about safety, staffing, pricingMcKnight's Senior Living, by Kimberly Bonvissuto; 1/17/24The US Senate Special Committee on Aging is launching a review of the assisted living industry following recent articles in the Washington Post, which reported on the deaths of residents who wandered from communities, as well as the New York Times and KFF, which scrutinized an industry pricing structure that adds fees on top of basic charges to cover additional services, as well as rate increases and the for-profit status of most providers.

OIG report has clues for 2024 healthcare fraud enforcementLAW360, by Mackenzie Wortley, Elizabeth Nevins and Megan Miller; 1/16/24In late 2023, the U.S. Department of Health and Human Services and the U.S. Department of Justice released the Health Care Fraud and Abuse Control Program Annual Report for fiscal year 2022, highlighting continued enforcement and recovery actions under the program.

Nurse pleads guilty to federal charge for stealing pain medications at Baxter clinicBrainerd Dispatch; 1/9/24A registered nurse pleaded guilty to fraudulently obtaining prescription opioid pain medications from a hospice clinic, United States Attorney Andrew M. Luger announced Tuesday, Jan. 9. ... Cambie Elizabeth Broker, 33, was a registered nurse case manager at a hospice clinic in Baxter. Broker used her position to fraudulently obtain controlled substances from the clinic. Broker entered false prescription requests into the clinic’s e-prescribing software to fraudulently obtain oxycodone, hydromorphone, and fentanyl for illegal sale and personal use. 

Home healthcare company agrees to pay nearly $10 million to resolve false claims act allegations relating to its participation in the energy employees occupational illness compensation programOffice of Public Affairs; 1/5/24Atlantic Home Health Care LLC (AHH), a home health care agency operating in Arizona and eight other states, has agreed to pay $9,990,944 to resolve allegations that it violated the False Claims Act by submitting false claims to the Energy Employees Occupational Illness Compensation Program (EEOICP or the Energy Program), a healthcare program administered by the Department of Labor (DOL) for the benefit of Department of Energy employees and contractors with occupational illnesses.