A whistleblower complaint by a hospice employee led to a $5.59 million settlement. Allegations include:
- Double dipping by charging Medicare for therapy when those services are already covered by Medicare hospice coverage.
- Patients that did not quality for hospice services.
Why it matters: The feds have been and will continue to be laser focused on false claims allegations. Per U.S. Attorney Zachary A. Myers, “Health care providers who submit false claims or otherwise violate state and federal regulations when billing the United States Government will face consequences.”
Whistleblower claims – a closer look: The whistleblower provision of the False Claims Act encourages people to reach out to the OIG if fraud is suspected. With a settlement, a whistleblower is entitled to between 15% and 25% of the settlement.
Compliance takeaways: Your compliance program should include:
- Auditing claims to ensure no claims are submitted for services already covered by Medicare.
- Verification that hospice coverage requirements are met with required documentation:
- Patient (or authorized representative) agrees to hospice care by signing a hospice election statement.
- Patients meet "terminally ill" requirements - a physician's certification that an individual's prognosis is a life expectancy of six month or less if the terminal illness runs its normal course
Promotion of internal whistleblowing (via your hotline) so YOU can fix problems before the government does.