The Justice Department has stepped in to stop what it calls a brazen scheme by the Orlando-based Hospice of the Comforter Inc. (HOTCI) to bilk Medicare out of millions by falsifying claims for patients who didn’t qualify for the benefit.
According to the government, HOTCI’s former vice-president of finance, Douglas Stone, blew the whistle on the practice, alleging that the hospice’s CEO verbally instructed employees to admit Medicare recipients for hospice care even when they weren’t terminally ill.
The lawsuit, filed under the False Claims Act, alleges that HOTCI knowingly submitted false claims to Medicare for patients who didn’t qualify for the benefit. Specifically, the lawsuit contends that HOTCI’s CEO instructed employees to admit Medicare recipients for hospice care even when there had not yet been a determination that they were eligible for the hospice benefit.
“The hospice benefit is intended only for people who qualify for and require such care,” said Stuart F. Delery, Acting Assistant Attorney General for the Civil Division of the Department of Justice. “We will continue to protect this important component of the Medicare program by ensuring that entities providing hospice care are only treating, and billing for, qualified patients.”
“Some of the most vulnerable people in our district rely on hospice services,” said Robert O’Neill, U.S. Attorney for the Middle District of Florida. “It is critically important that Medicare remains solvent in order to provide hospice benefits, and that we confront those whose practices in this area put economic gain before patient care.”
The Justice Department’s intervention in this case is part of a larger effort to combat healthcare fraud and prevent financial losses for Medicare and Medicaid. Since January 2009, the department has recovered over $13 billion in cases involving fraud against federal healthcare programs, including more than $9.3 billion in cases related to healthcare fraud.
The lawsuit alleges that HOTCI’s scheme resulted in the submission of false claims to Medicare for patients who didn’t qualify for the benefit. The government has intervened in the lawsuit, which was filed under the whistleblower provisions of the False Claims Act, and will take over primary responsibility for litigating the case.
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