Are you a nurse, physician, pharmacist, technician, pharmaceutical representative, or other healthcare professional? Do you believe your hospice provider might be defrauding the Medicaid or Medicare program?

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Healthcare professionals with inside knowledge of their employer making fraudulent claims against Medicare must report the fraud to the government.

We Represent Employees with Inside Knowledge of Hospice Fraud. 

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The Law Office of Sara J. Saba, P.A. helps nurses, doctors, techs, and other healthcare professionals report the fraud for a Whistleblower Cash Award that they are entitled to under the False Claims Act 31 U.S. Code § 3729.

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What Is Hospice Fraud? 

 

Hospice care focuses on comfort and quality of care for the terminally ill. The amount of fraud and abuse against Medicare hospice benefits has increased by 43 percent from 2006 to 2016. 

 

Hospice fraud can occur in a variety of ways:

 

• Offering the hospice benefit to a beneficiary who has not been certified terminally ill with a life expectancy of six months or less by a physician

• Inflating the level of care beyond what the patient actually needs

• Bribing beneficiaries to agree to a hospice level of care when they are unlikely to be terminally ill

• Ordering redundant or unnecessary equipment and medication

• Paying incentives to referral sources (i.e., physicians and nursing homes)

• Billing for a higher level of care than was actually provided, or billing for the most expensive level of care when it was not medically necessary

• Falsifying records, certifications, or patient charts 

• Improperly retaining hospice patients whose health is improving rather than declining

• Maintaining inadequate medical records that do not justify admission or retention

• Paying a bonus based on the volume of hospice patients admitted

• Keeping patients on hospice without medical justification

• Providing curative care to hospice patients

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What Are Fraudulent Kickbacks?

 

Hospices may not give kickbacks to nursing homes and hospitals in exchange for patient referrals. 

 

Examples of fraudulent kickbacks include:

 

• Hospice providers supplying nursing homes with free or discounted goods or hospice services in exchange for patient referrals

• Hospice facilities referring patients to nursing homes in order to encourage the nursing homes to refer patients back to hospices 

• Hospice facilities providing free or discounted skilled nursing services to a nursing home, even when the nursing home is already receiving Medicare payments for these services (The hospice may do this with the expectation that when the patient is eligible for hospice care, the hospice company will be contracted at the nursing home.)

 

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