Hospice of the Comforter Settles Whistleblower/Qui Tam Lawsuit
Thursday, October 31, 2013
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health LawOn October 28, 2013, a Florida federal judge approved a $3 million settlement in a False Claims Act lawsuit alleging Hospice of the Comforter Inc. (HOTCI), defrauded Medicare. The judge shot down objections from the whistleblower (sometimes called a “relator” or “plaintiff” who argued that the settlement amount is unfair, according to the Orlando Sentinel.Click here to read the entire article from the Orlando Sentinel on the settlement.The nonprofit hospice is located in Altamonte Springs, a suburb of the Orlando area, and provides hospice services to local patients.
Medicare Fraud Claims Against the Hospice.According to Law 360, the lawsuit was filed by the former vice president of finance for HOTCI. The case alleged HOTCI submitted false claims to Medicare for hospice care patients who were not terminally ill. The lawsuit also stated the hospice’s CEO allegedly told employees to admit Medicare recipients for hospice care even before there had been a determination that the patients were eligible for the hospice benefit. The Department of Justice (DOJ) joined the lawsuit in August 2012. To read our previous blog on this, click here.
Settlement Calls for More Than Just a Monetary Payment.The settlement calls for a $3 million payment spread over five years, according to Law 360. In the settlement, the hospice’s former CEO is also excluded from involvement in any government health care program for three years. According to Law 360, there is also a corporate integrity agreement (CIA) between the HOTCI and the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG). Click here to read the Law 360 article.Whistleblower Calls Settlement Amount a Travesty.The whistleblower spoke to the Orlando Sentinel about the repayment amount and called it unreasonably low. He stated that the $3 million settlement sends the message that cheating the government is profitable. It was argued that the HOTCI should pay as much as $30 million, based on the more than 200 potential cases of alleged Medicare fraud. The whistleblower will receive a percentage of the amount collected by the government. It is estimated he will get at least $450,000, but it could be as much as almost $1 million. Click here to read the Orlando Sentinel article with an interview of the whistleblower.Most Qui Tam Claims Filed by Employees.From our review of qui tam cases that have been unsealed by the government, it appears most of these are filed by physicians, nurses or hospital staff employees who have some knowledge of false billing or inappropriate coding taking place. Normally the government will want to see some actual documentation of the claims submitted by the hospital or other institution. Usually physicians, nurses or staff employees have access to such documentation. Whistleblowers are urged to come forward as soon as possible. In many circumstances, documentation that shows the fraud “disappears” or cannot be located once it is known that a company is under investigation.To learn more on whistleblower/qui tam cases, read our two-part blog. Click here for part one, and click here for part two.Contact Health Law Attorneys Experienced with Qui Tam or Whistleblower Cases.Attorneys with The Health Law Firm also represent health care professionals and health facilities in qui tam or whistleblower cases both in defending such claims and in bringing such claims. We have developed relationships with recognized experts in health care accounting, health care financing, utilization review, medical review, filling, coding, and other services that assist us in such matters. We have represented doctors, nurses and others as relators in bringing qui tam or whistleblower cases, as well.To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.Comments?Individuals working in the health care industry often become aware of questionable activities. Often they are even asked to participate in it. In many cases the activity may amount to fraud on the government. Has this ever happened to you? Please leave any thoughtful comments below.Sources:Santich, Kate. “Hospice of the Comforter to Pay $3M in Fraud Case.” Orlando Sentinel. (October 30, 2013). From: http://www.orlandosentinel.com/health/os-hospice-fraud-case-settlement-20131030,0,7502267.storySantich, Kate. “Whistle-Blower: Hospice of the Comforter Settlement is Unfair.” Orlando Sentinel. (October 15, 2013). From: http://www.orlandosentinel.com/health/os-hospice-fraud-settlement-20131015,0,6268632.storyChiem, Linda. “Fla. Hospice’s $3M FCA Settlement Gets Courts OK.” Law 360. (October 28, 2013). From: http://www.law360.com/employment/articles/483993/fla-hospice-s-3m-fca-settlement-gets-court-ok
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 lawsuit, whistleblower, whistleblower lawsuit, whistleblower protection, fraud defense, Department of Justice (DOJ), fraud prevention, Medicare, Medicare fraud, defense attorney, defense lawyer, legal representation, government health programs, Medicare audit, Florida Medicare, fraud schemes, Medicare overbilling, Hospice of the Comforter, Inc. (HOTCI), whistleblower settlement, The Health Law Firm
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