On July 8, Hope Hospice of Fort Myers, Florida, agreed to pay $3.2 million to settle allegations of Medicare, Medicaid, and TRICARE fraud. Margaret Peters, the former Director of Hospice Care, filed the lawsuit under the qui tam, or whistleblower, provisions of the False Claims Act. Peters claimed that Hope Hospice was charging federal and state health programs for hospice care for patients who did not meet qualifications. Hospice care is available under Medicare, Medicaid, and TRICARE for patients whose life expectancy is less than six months. Hope Hospice allegedly charged Medicare for more than four years of hospice care for some patients when they were not terminally ill. The suit alleged that the hospice group knowingly submitted these false claims to Medicare, Medicaid, and TRICARE.
Hospice gives end-of-life care to terminally ill patients and makes them comfortable at the end of their lives. There are four levels of hospice care: routine home care, continuous home care, inpatient respite care, and GIP (General Inpatient). GIP is the most rigorous level of care and is the costliest. Hope Hospice allegedly charged Medicare, Medicaid, and TRICARE for GIP levels of care for patients who only needed lower levels of care. This practice allowed Hope Hospice to collect more money from federal and state medical programs. Many of the patients who were taken advantage of were seriously ill in this case and were not capable of fighting this fraud alone.
Under the False Claims Act, whistleblowers, or relators, can bring lawsuits on behalf of the government. Relators stand to collect 15 to 30% of the total funds recovered by the government. For her critical role in this case, Peters will receive 19% of the settlement. Reporting medical fraud is essential to keeping our healthcare system affordable and functional. This type of fraud is not a victimless crime: patients may receive the wrong standard of care because of it. The False Claims Act has repeatedly shown its effectiveness in protecting whistleblowers and stopping medical fraud.