Are Medicare Investigations Leaving the Hospice Industry on Life Support?

Wednesday, January 23, 2013

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

It’s no surprise to anyone that Medicare is cracking down on hospices around the country. According to a report by the Office of Inspector General (OIG), eighty-two percent (82%) of hospices’ claims did not meet Medicare coverage requirements. That is why Medicare is investigating the industry as a whole. Specific details on what Medicare is looking for can be found in the 2013 OIG Work Plan. Click here to read more the 2013 OIG Work Plan.

So far, Medicare has kept true to its word. During the week of January 7, 2013, the federal government announced it is suing a Central Florida hospice for Medicare fraud, according to the Orlando Sentinel. (Click here to read the Orlando Sentinel article.) Also, one of the nation’s largest and most respected hospices located in San Diego, California, is in the middle of a federal audit, according to a Kaiser Health News article. (Click here to read the Kaiser Health News article.) These are just a few examples of what hospices around the country are dealing with.


Whistleblower Calls Out Central Florida Hospice for Medicare Billing Issues.

The federal qui tam (whistleblower) lawsuit against the Central Florida hospice was reportedly filed by the hospice’s former vice president of finance in September 2011. The Department of Justice (DOJ) joined the whistleblower lawsuit in September of 2012.

The federal lawsuit alleges the hospice CEO ordered employees to admit patients without properly determining whether they were terminally ill, as required by Medicare. Staff was also apparently told to find ways to “edit” patients’ medical files so that the billing appeared legitimate. To learn more on this case, click here to read a blog I wrote on the hospice when the government joined the lawsuit. Click here to read the entire whistleblower complaint.


Audit Causes San Diego Hospice to Cut Back on Patients and Employees.

In 2010, federal officials audited a large hospice located in San Diego, California. Medicare is still investigating the hospice’s 2009-2010 admissions. Since the audit, the hospice has had to drop around 400 patients, due to their ineligibility for hospice care. Cutting patients meant a decrease in profits, which subsequently meant the hospice had to let 260 employees go and close a 24-bed hospital, according to Kaiser Health News.


Why Are Hospices Being Targeted?

According to the Kaiser Health News article, the hospice industry is booming. In 2011, it’s estimated hospices served 1.65 million people in the U.S., which is about forty-five percent (45%) of all those who died that year. Medicare paid for the hospice benefits of eighty-four percent (84%) of those patients.

Medicare is concerned with the amount of people hospices admit. Hospices normally treat patients with fewer than six months to live. If a patient recovers, Medicare expects the patient to leave the program. Patients may stay in hospice care only if they are re-certified as still likely to die within six months by a physician. It’s thought that enrollment bonuses to employees and kickbacks to nursing homes that refer patients are big factors as to why hospices accept ineligible patients.


Medicare Committed to Finding Fraud and Abuse.

Currently, the Centers for Medicare and Medicaid Services (CMS) is focused on safeguarding tax payers dollars from fraud. I have recently seen a number of audits initiated against health professionals who treat assisted living facility (ALF), hospice and skilled nursing facility (SNF) residents. Most often these are audits by the Medicare Administrative Contractor (MAC), because these facilities have been identified as fraught with fraud and abuse. I wrote a two-part blog this topic. Click here for part one and here for part two.

If you are being audited, click here to read some tips we recommend in responding to a Medicare audit.


Contact Health Law Attorneys Experienced in Handling Medicaid and Medicare Audits.
 
The Health Law Firm's attorneys routinely represent physicians, medical groups, clinics, pharmacies, nurses, durable medical equipment (DME) suppliers, home health agencies, nursing homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
 
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?

What do you think about Medicare targeting hospices? Do you think it is necessary? Is the hospice business going to suffer because of these investigations? Please leave any thoughtful comment below.


Sources:

Santich, Kate. “Feds Sue Hospice of the Comforter for Medicare Fraud.” Orlando Sentinel. (January 14, 2013). From: http://www.orlandosentinel.com/news/local/breakingnews/os-feds-sue-hospice-of-the-comforter-20130114,0,7827264.story

U.S. ex rel. Stone v. Hospice of the Comforter, Inc., No. 6:11-cv-1498-ORL-22-AAB (M.D. Fla) United State District Court for the Middle District of Florida Orlando Division. (September 12, 2012), available at http://www.thehealthlawfirm.com/uploads/US%20v%20Hospice%20of%20the%20Comforter.pdf

Dotinga, Randy. “Slowly Dying Patients, Am Audit and A Hospice’s Undoing.” Kaiser Health News. (January 16, 2013). From: http://www.kaiserhealthnews.org/Stories/2013/January/16/san-diego-hospice.aspx


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.


Tag Words: False Claims Act, FCA, qui tam suits, whistleblower, whistleblower protection, fraud defense, Department of Justice (DOJ), fraud prevention, Medicare, Medicare fraud, Medicare audit, defense attorney, defense lawyer, legal representation, government health programs, audit, Florida Medicare, fraud schemes, Medicare overbilling, hospice fraud, hospice audit, hospice investigation, kickback, Centers for Medicare and Medicaid Services (CMS), Medicare Administrative Contractor (MAC)

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
Copyright © 1996-2012 The Health Law Firm. All rights reserved.

1/23/2013

Comments:

Response to: Are Medicare Investigations Leaving the Hospice Industry on Life Support?
Thursday, January 31, 2013
Cynthia says:

I believe from personal experience that there are some Hospice organizations that provide an amazing service to individuals and their families, and some seem to be in the "business" just to make money. I had a fantastic organization assist us when my mother was in her last months, and years before that I had a horrible experience with a different company who was never there to assist with medication or anything else we needed in the last 2 weeks of my father's life and truly did not seem to care about helping us. In both cases, both organizations were quick to supply products and equipment that was not needed and I know it cost Medicare money. I want the hospice industry to survive for the benefits to families, but I think they are all abusing the system and taking money from Medicare so that when my husband and I may need their services, Medicare may be broke!

Response to: Are Medicare Investigations Leaving the Hospice Industry on Life Support?
Friday, February 1, 2013
The Health Law Firm says:

Cynthia, thank you for your insightful comment! We appreciate your opinion.

Response to: Are Medicare Investigations Leaving the Hospice Industry on Life Support?
Friday, March 1, 2013
Vanessa Elizebeth says:

It's not clear how many hospice programs are being investigated. But there's definitely an increased level of scrutiny. http://www.medicarearkansas.com/

Response to: Are Medicare Investigations Leaving the Hospice Industry on Life Support?
Monday, March 28, 2016
Julianne Ross says:

I have worked as a Hospice Nurse for 6 years, and while important services are provided, closer scrutiny is necessary to ensure that the benefit is necessary and not being abused. Staff in skilled nursing facilities and ALFs, as well as patients with Dementia admitting diagnoses should be reviewed closely.

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