Odyssey HealthCare, Medicare Fraud, Wisconsin 2010

A healthcare provider has agreed to pay $25 million to resolve civil liability under the federal False Claims Act arising from its billing of claims for certain hospice services.

Odyssey HealthCare, a subsidiary of Gentiva, has agreed to pay the fine after allegations that the company submitted false claims to the Medicare program for continuous home care services that were unnecessary or not performed in accordance with Medicare requirements between January 2006 and January 2009.

The Medicare hospice benefit is available for patients who elect palliative treatment for a terminal illness. Patients are eligible for palliative hospice care if they have a terminal diagnosis of six months or less if their disease runs its normal course.

The majority of hospice services are billed at the routine care level. Medicare also pays for higher levels of care, including continuous home care. Continuous care is available when the patient is experiencing an acute crisis and their symptoms can only be controlled at home through the provision of skilled nursing services.

Today’s settlement resolves allegations that Odyssey submitted false claims to the Medicare program for continuous home care services that were unnecessary or not performed in accordance with Medicare requirements between January 2006 and January 2009.

The whistleblowers, all former employees of Odyssey, will receive payments totaling more than $4.6 million as a part of today’s resolution.

In addition to the $25 million payment, Odyssey entered a five-year corporate integrity agreement with the United States Department of Health and Human Services Office of the Inspector General.

The cases resolved by today’s settlement are United States ex rel. Rouse et al. v. Odyssey Health Care, Inc. (Case No. 08-C-0383, E.D. Wisc.); U.S. ex rel. Dingus v. Odyssey Health Care, Inc., (Case No. 09-C-0254, E.D. Wisc.); and U.S. ex rel. Smithwick v.

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