Atlanta hospice to pay $3 million in Medicare fraud case

A Georgia hospice company has agreed to pay $3 million to resolve allegations it billed taxpayers for patients who were not terminally ill, the latest such settlement as federal officials target what they call a burgeoning number of abusive hospice schemes.

Guardian Hospice set aggressive targets to recruit and enroll patients it knew were not in the last months of their lives so it could collect Medicare payments, the federal government alleged. In agreeing to the settlement, the for-profit company, which serves the Atlanta area, did not admit liability.

The federal government joined forces with former Guardian employees Rose Betts and Jennifer Williams, nurses who brought the case in 2012 under whistleblower provisions of the federal False Claims Act. The women alleged they routinely saw non-terminal patients being treated but were told it was necessary to keep the hospice’s “census” up, said their attorney, Mike Bothwell of The Bothwell Law Group.

He said that the practice was “doubly cruel” because when unqualified patients are put on hospice, they are forced to forego regular medical care that could help cure their illness.

The women will receive about $510,000 of the money recovered. In addition, the women will receive payments for being retaliated against as whistleblowers, according to the settlement agreement.

Officials of Guardian’s parent company could not immediately be reached for comment.

Hospices have been under increasing scrutiny for fraud and abuse as Medicare payments for the care has more than doubled over five years. The hospice benefit is only for those diagnosed with a terminal illness and a life expectancy of six months or less, but in some cases patients have been in hospice care for years. In what the government calls other illicit schemes, hospices have billed Medicare for services patients didn’t receive.

Civil and criminal cases have been filed across the nation. In February, a New York hospice agreed to pay more than $6 million to settle a lawsuit and an Oklahoma-based hospice agreed to pay $4 million. In March, a federal grand jury indicted a top official of a Louisiana hospice. In August, an executive of an Oklahoma hospice was sentenced to prison and ordered to repay $2.5 million. In September, a Tennessee hospice paid $1.5 million to resolve a lawsuit, and a Baton Rouge-based chain of hospices in four states agreed to pay $5.9 million in another settlement.

Pending is another case with Georgia ties. An Alabama jury on Monday resumes deliberations in the lawsuit against hospice provider AseraCare, which operates some 60 facilities in 19 states, including Georgia. The Justice Department claims it caused non-terminally ill patients to give up curative or rehabilitative care so the company could bill for hospice payments. As a result, the government alleged Medicare improperly paid $67.5 million to the company.

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