September 11, 2015

DOJ Catch of the Week — Alive Hospice

By the C|C Whistleblower Lawyer Team

This week’s Department of Justice “Catch of the Week” goes to Tennessee-based non-profit hospice care provider Alive Hospice, Inc. Yesterday, the DOJ announced the company paid roughly $1.5 million to reimburse the government for alleged violations of the False Claims Act through overbilling of Medicare and TennCare for hospice services. See DOJ Press Release.

The Medicare and TennCare hospice benefits are available for patients nearing the end of their life.  They reimburse for routine home care, continuous home care, inpatient respite care, and general inpatient care.  General inpatient services are for pain control or symptom management that cannot be managed in other settings, such as a patient’s home.  Medicare and TennCare reimburse for general inpatient care at a higher rate than that paid for routine home care or inpatient respite care. According to the government, Alive submitted claims to Medicare and TennCare for general inpatient hospice care for patients who did not qualify for that care.

In announcing the settlement, the government noted the increase in fraud from hospice providers and the need to take action against companies that try to take advantage of this particularly vulnerable group of patients. Derrick L. Jackson, the Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta, said: “We are seeing a trend of false claims involving hospice providers . . . overbilling the Medicare program and taking advantage of patients at a particularly vulnerable point in their lives.  HHS-OIG will continue to pursue providers who overbill these programs and will seek appropriate remedies through the U.S. Attorney’s Office.”

The allegations against Alive originated in a whistleblower lawsuit filed by Linda Anderson, a triage nurse who previously worked for Alive, under the qui tam provisions of the False Claims Act. She will receive a whistleblower award of $263,197 as her share of the settlement.

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One Response to “DOJ Catch of the Week — Alive Hospice

  1. They got off easy! $1.5M is just the tip of the iceberg! I worked there during the time period under discussion. There’s a lot more than over-billing that they need to be called on… Of course, they have a warm and fuzzy reputation in the community because they deal with death, but their treatment of staff and at times inept care are so bad they can’t keep a medical or clinical director. Pretty sad.