Hospice Care Fraud Prosecutions
Hospice Care Fraud: Overview and Legal Framework
What is Hospice Care Fraud?
Hospice care fraud typically involves fraudulent billing, false claims, and misrepresentation related to Medicare or Medicaid hospice services.
Examples include billing for unnecessary services, enrolling ineligible patients, falsifying patient records, or overcharging for care.
Because hospice care is mostly funded by Medicare, fraud against federal health programs is prosecuted under laws like:
Relevant Laws
False Claims Act (FCA), 31 U.S.C. §§ 3729–3733: Prohibits submission of false claims for government funds.
Health Care Fraud Statute, 18 U.S.C. § 1347: Criminalizes schemes to defraud health care benefit programs.
Anti-Kickback Statute (AKS), 42 U.S.C. § 1320a-7b(b): Prohibits payments to induce referrals for services reimbursed by federal programs.
Civil Monetary Penalties Law (CMPL): Imposes fines for fraudulent practices.
Notable Hospice Care Fraud Prosecutions
1. United States v. Gentiva Health Services (2013)
Background:
Gentiva, a large national hospice and home health provider, faced allegations of billing for unnecessary hospice services and improperly enrolling patients not eligible for hospice.
Facts:
Investigations revealed Gentiva submitted Medicare claims for patients who did not meet hospice eligibility criteria.
The company allegedly pressured employees to meet billing quotas.
Charges:
Violations of the False Claims Act.
Health care fraud.
Outcome:
Gentiva agreed to pay $40 million to settle federal claims without admitting wrongdoing.
Settlement included corporate integrity agreements to improve compliance.
Highlighted how large providers face scrutiny over billing practices.
2. United States v. Hospice of Louisiana, LLC (2018)
Background:
A hospice provider in Louisiana was charged with enrolling patients into hospice care who did not meet eligibility requirements and billing Medicare for fraudulent claims.
Facts:
Providers allegedly falsified patient diagnoses to qualify for hospice.
Patients received unnecessary or no services, but bills were submitted.
Charges:
False Claims Act violations.
Health care fraud.
Kickback-related charges for improper referral incentives.
Outcome:
The company and executives paid over $9 million in settlements.
Several executives faced criminal charges.
The case underscored the risk of kickback schemes in hospice referrals.
3. United States v. LifeCare Hospice and Palliative Care (2017)
Background:
LifeCare Hospice was investigated for fraudulent billing practices and improper enrollment of patients not terminally ill.
Facts:
Providers billed Medicare for hospice services without proper certification of terminal illness.
Patient charts were falsified or inadequately documented.
Charges:
False Claims Act.
Health care fraud.
Outcome:
LifeCare agreed to pay $6.8 million in restitution.
Company entered a corporate integrity agreement.
Emphasized documentation and certification importance.
4. United States v. Advanced Care Hospice (2019)
Background:
Advanced Care Hospice was accused of submitting claims for services that were never provided or medically unnecessary.
Facts:
Medicare claims included billing for home visits that did not occur.
Patients enrolled in hospice without proper evaluation.
Charges:
Health care fraud.
False Claims Act violations.
Outcome:
The company paid a $12 million settlement.
Several staff members were indicted for conspiracy and fraud.
Reinforced consequences for fraudulent billing and patient enrollment.
5. United States v. SouthernCare Hospice (2015)
Background:
SouthernCare Hospice faced allegations related to fraudulent enrollment of patients and billing for unprovided services.
Facts:
Hospice allegedly enrolled patients who were not terminally ill.
Billing was submitted despite lack of proper physician certification.
Charges:
Violations of the False Claims Act.
Health care fraud.
Kickback-related allegations.
Outcome:
SouthernCare paid $18 million to resolve claims.
Senior officials faced criminal charges.
This case illustrated regulatory focus on eligibility and certification.
Summary and Key Themes
Hospice care fraud prosecutions focus on fraudulent Medicare/Medicaid billing, improper patient enrollment, and kickbacks.
Large settlements and criminal charges against executives are common.
Federal authorities use the False Claims Act and health care fraud statutes to recover billions in improper payments.
Compliance programs, documentation, and proper certification of terminal illness are central to prevention.
Cases often involve falsification of patient records, overbilling, and pay-for-referral schemes.
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