Jacksonville, Florida – In a shocking case of Medicare fraud, Haven Hospice, a hospice company headquartered in Gainesville, Florida, has agreed to pay $5,085,024 to resolve allegations that the company knowingly billed the government for medically unnecessary and undocumented hospice services.
The government alleges that Haven Hospice knowingly submitted false claims to the Medicare and Medicaid programs for medically unnecessary hospice care for certain patients who had lengths of stays greater than three years. Typically, federal health care programs only pay for hospice care when patients are in a terminal condition and have a life expectancy of less than six months.
Since June 1, 2011, Haven Hospice treated at least 63 patients with lengths of stays exceeding three years. The government contends that for those 63 patients, Haven Hospice either knowingly or recklessly failed to document a valid basis for the initial start of hospice care and/or subsequent hospice coverage.
Haven Hospice’s diagnoses were not adequately supported, or were supported only with inconsistent practitioner information. Many patients failed to demonstrate objective indications of decline throughout their time in the company’s care, despite some being in hospice for nearly six years. Some patients had their hospice diagnoses changed after several years when they did not show decline under their original “terminal” diagnosis.
Acting U.S. Attorney W. Stephen Muldrow stated, “Unfortunately, some healthcare providers seek to defraud Medicare by billing for unnecessary hospice services. Left unchecked, this misconduct would deplete funds available for terminally ill patients desperately in need of the relief that hospice care provides. This settlement should serve as notice to others who consider similar practices that we will vigorously pursue them.”
The settlement concludes a lawsuit originally filed in the United States District Court for the Middle District of Florida by a former employee of Haven Hospice, Dr. John Simons. The lawsuit was filed under the qui tam, or whistleblower, provisions of the False Claims Act that permits private individuals to sue on behalf of the government for false claims and to share in any recovery.
The government’s action in this matter illustrates the emphasis on combating health care fraud, and one of the most powerful tools in this effort is the False Claims Act. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).
The case is captioned United States ex rel. Simons v. North Central Florida Hospice, Inc. d/b/a Haven Hospice, Case No. 3:16-cv-330-J-32JRK. The settlement resolves the United States’ claims in that case. The claims resolved by the settlement are allegations only, and there has been no determination of liability.
Defendant: Haven Hospice, Exact criminal charges: Medicare Fraud, City and state: Jacksonville, Florida, Exact date: Not specified, Sentence/outcome: Paid $5,085,024, Dollar amounts: $5,085,024.
Key Facts
- State: Florida
- Category: White Collar Crime
- Source: DOJ Press Release â†â€â€
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