STG Healthcare of Atlanta, Inc. et al, Hospice Benefit Fraud, Georgia 2023

ATLANTA – A Georgia-based hospice provider and its senior executives have agreed to pay $1.75 million to resolve allegations that they submitted or caused the submission of false claims to Medicare and Medicaid for patients who were not eligible for the hospice benefit.

STG Healthcare of Atlanta, Inc. (“STG Healthcare”) and two of its senior executives, Paschal “Pat” Gilley and Mathew Gilley, have reached the settlement with the U.S. Attorney’s Office for the Northern District of Georgia.

The alleged false claims were submitted between 2013 and 2017, according to the government. During this time, STG Healthcare allegedly submitted claims for patients who were not terminally ill, and also paid a physician to refer patients to the hospice provider in violation of the Anti-Kickback Statutes.

“Hospice is not a blank check for unscrupulous medical providers willing to admit patients who are not terminally ill,” said U.S. Attorney Byung J. “BJay” Pak. “It is reserved for those who truly need it. We will also continue to prioritize cases where it appears that a medical decision, especially the decision to forego curative treatment, has been influenced by a kickback.”

The Medicare and Medicaid hospice benefit is available for patients who elect palliative treatment for terminal illness and have a life expectancy of six months or less if their illness runs its normal course. Before billing government healthcare programs, a hospice provider must comply with Medicare and Medicaid’s requirements and ensure that patients who are foregoing curative care are in need of end-of-life care.

The settlement resolves allegations filed by Serita Samuel and Miranda Eskridge, former STG Healthcare employees, under the qui tam, or whistleblower, provisions of the False Claims Act, which authorizes private parties to sue for false claims on behalf of the United States and share in the recovery.

Defendant:

STG Healthcare of Atlanta, Inc.

Criminal Charges:

Filing false claims to Medicare and Medicaid

City and State:

Atlanta, Georgia

Exact Date:

Not specified

Sentence or Outcome:

Paid $1.75 million to resolve allegations

Dollar Amount:

$1.75 million

Source: https://www.justice.gov/usao-ndga/pr/hospice-pay-175-million-resolve-false-claims-act-allegations