On November 23, the U.S. Department of Justice (DOJ) announced that a hospice care provider will pay $5.5 million “to resolve allegations that they violated the False Claims Act by submitting claims to Medicare for non-covered hospice services.”
Carrefour Associates LLC, Crossroads Hospice of Cincinnati LLC, Crossroads Hospice of Cleveland LLC, Crossroads Hospice of Dayton LLC, Crossroads Hospice of Northeast Ohio LLC, and Crossroads Hospice of Tennessee LLC are together known as Crossroads Hospice in this press release. They operate in Ohio and Tennessee, and the DOJ states that the settlement “resolves allegations that Crossroads Hospice knowingly submitted false claims to Medicare for hospice services for patients who were not terminally ill.”
Hospice care, the DOJ explains in the press release, “is special, end-of-life care intended to comfort terminally ill patients.” Patients in hospice care “generally stop receiving coverage for traditional medical care designed to cure their terminal condition,” instead shifting to “receive medical care focused on provided them with relief from the symptoms, pain and stress of a terminal illness.” According to the press release, “Medicare patients are considered to be terminally ill and hospice-eligible when they have a life expectancy of six months or less if their illness runs its normal course.”
The settlement describes that the U.S. alleged that between January 1, 2012, to December 31, 2014, “Crossroads Hospice billed Medicare for hospice care for certain patients” who were diagnosed with dementia or Alzheimer’s disease and “who were not terminally ill for at least a portion of the more than three years that the patients received care” at its Ohio and Tennessee locations.
The civil settlement of these allegations “includes the resolution” of claims made under the False Claims Act’s qui tam provisions. These whistleblower provisions allow private citizens to file lawsuits on behalf of the federal government if they know that an individual or company is defrauding the government. Qui tam whistleblowers can then receive a portion of “any recovery.” In this case, former Crossroads Hospice employees Leanne Malone, Jackie Burns, and Angela Heck, as well as Dr. David Weber, “a home health physician in Tennessee,” were the ones to blow the whistle. “Under this settlement, the whistleblowers in the Malone action will receive approximately $1,045,000,” the DOJ states.
“Medicare’s hospice benefit provides critical end of life services that focus on palliative rather than curative care,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “This settlement demonstrates our continuing commitment to ensure that hospice services are provided to patients who truly need this care and that patients who are not terminally ill receive appropriate curative care.”
“This office is committed to pursuing providers who put profits ahead of patients,” added Acting U.S. Attorney Vipal J. Patel for the Southern District of Ohio. Patel emphasized a commitment to hold abusers of federal healthcare programs accountable.
Both Acting U.S. Attorney Joseph C. Murphy Jr. for the Western District of Tennessee and Special Agent in Charge Lamont Pugh III of the Department of Health and Human Services Office of Inspector General mentioned the harm this alleged fraudulent activity does to patients and federal medical programs like Medicare. “When frauds like this are committed by serviced providers, it effectively deprives older Americans of health care resources,” Murphy said. “The decision to provide hospice services should be prompted by a patient’s terminally ill medical diagnosis and desire for palliative care, not a hospice provider’s desire to boost its profits,” Pugh pointed out.
At the end of the press release, the DOJ emphasizes the False Claims Act’s importance in shedding light on healthcare fraud, which can erode trust in federal medical programs and the healthcare system itself. Whistleblower experts have long hailed the False Claims Act as one of the best whistleblower laws in the U.S. Just recently, the Senate Judiciary Committee voted to advance bipartisan amendments to the Senate floor. The amendments would make “essential fixes” to the Act, in the words of Senator Chuck Grassley (R-IA). Read more about what the amendments entail \here.