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Catch of the Week — Hospice Provider to Pay $6 Million to Settle False Claims Act Suit

Posted  December 21, 2018

SouthernCare, Inc., a hospice provider owned by Curo Health Services, has agreed to pay the federal government nearly $6 million dollars to settle a lawsuit alleging that the company defrauded Medicare by billing medically unnecessary hospice care. The fraud was unearthed by two whistleblowers formerly employed by the company, who filed suit under the qui tam provisions of the False Claims Act, where they will share $1.1 million of the government’s recovery.

To place a patient in Medicare-funded hospice care, a physician must certify the patient as terminally ill, meaning the patient’s life expectancy is six months or less. Specific medical documentation of the patient’s prognosis must support the certification. Despite these requirements, SouthernCare allegedly treated some patients for years at a time and lacked supporting documentation of medical need for others. Although the settlement covers misconduct spanning from 2009 to 2014, SouthernCare was already operating under a corporate integrity agreement arising from a 2009 whistleblower lawsuit alleging similar fraud.

The U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG)-which protects the integrity of federal health care programs and the welfare of program beneficiaries-has made rooting out hospice fraud a priority. In 2016 alone, Medicare paid $16 billion to fund hospice care for more than 1.4 million individuals. As explained by the HHS-OIG special agent in charge of the SouthernCare investigation, unnecessarily admitting people into hospice does more than cheat the Medicare program “it can cause patients who are not terminally ill to stop seeking treatments for recovery.”

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Tagged in: Catch of the Week, FCA Federal, Home Health and Hospice, Lack of Medical Necessity, Whistleblower Case,