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DOJ Catch of the Week -- Evercare

Posted  July 15, 2016

This week’s Department of Justice “Catch of the Week” goes to Evercare Hospice and Palliative Care.  On Wednesday, the Minnesota-based provider of hospice care agreed to pay $18 million to resolve charges it violated the False Claims Act by claiming Medicare reimbursement for hospice care for patients not eligible for such care because they were not terminally ill.  The government trumpeted the settlement as part of its continuing effort “to combat health care fraud and protect the nation’s elderly and most vulnerable citizens.”  See DOJ Press Release.

According to the government, Evercare submitted claims to Medicare for hospice care for patients not eligible for the Medicare hospice benefit because Evercare’s medical records did not support that they were terminally ill.  Specifically, the government alleged that Evercare’s business practices were designed to maximize the number of patients for whom it could bill Medicare without regard to whether the patients were eligible for and needed hospice.  This allegedly included discouraging doctors from recommending that ineligible patients be discharged from hospice and failing to ensure that nurses accurately and completely documented patients’ conditions in the medical records.

The allegations originated in whistleblower lawsuits filed by former employees of Evercare under the qui tam provisions of the False Claims Act.  They will receive a yet-to-be-determined whistleblower award from a share of the government’s recovery.  In announcing the settlement, DOJ Civil Chief Benjamin Mizer stressed the critical importance of healthcare providers abiding by the strict rules of the Medicare hospice program:

Our seniors rely on the hospice program to provide them with quality care, dignity and respect when they are terminally ill and need end-of-life care.  It is, therefore, critically important that we hold accountable those hospice providers that bill for medically unnecessary services in order to get higher reimbursements from the Medicare program. Such abuses threaten a vulnerable population and jeopardize this important benefit for others under the program.  The Justice Department will continue to protect taxpayer dollars and ensure that this critical benefit is available for Medicare patients who truly need it.

U.S. Attorney John Walsh for the District of Colorado echoed this sentiment, noting “[t]he decision to put someone into hospice care is an emotionally wrenching one for the patient and the patient’s family.  When hospice companies exploit and overbill Medicare by having people in hospice when they do not belong there, it jeopardizes this important benefit for others.  We will not tolerate such conduct.”

Tagged in: Catch of the Week, FCA Federal, Home Health and Hospice,