In the US District Court for the Middle District of Florida, Judge Anne
C. Conway has paved the way for the federal government to take the lead
in a Florida whistleblower complaint accusing Hospice of the Comforter,
a nonprofit facility, of regularly overbilling Medicare for patients that
don’t actually meet the qualification of terminally ill (allegedly
even allowing some of them to receive hospice care for up to five years).
According to Orlando Sentinel, that the US Department of Justice has chosen
to intervene is a sign that its probe into the allegations means that
it has likely found sufficient grounds for the Medicare Fraud claims.
The whistleblower that filed the original complaint is Douglas Stone, a Hospice of the Comforter’s ex-VP of Finance. He claims that he lost his job because he kept trying to persuade hospice CEO and founder Robert Wilson and a number of the members of the board to pay back Medicare for overbilling. Stone claims that Wilson was personally invested in keeping the alleged Medicare fraud going because the hospice’s daily census allowed him to receive over $200,000 in bonuses, which is a much larger some than his Wilson’s $120,000/year salary.
Under Medicare, hospice care is covered for people that a hospice doctor has certified as having a six months or less life expectancy due to a terminal illness. Unfortunately, hospice care fraud involving the overbilling for patient services to Medicare is not uncommon.
Hospices that engage in this type of fraud are trying to retain a certain amount of patients so that they can bill Medicaid, Medicare, or private insurance for this specialized care, even if they aren’t actually providing it.
Some examples of hospice Medicare fraud include:
• Hiring less than qualified employees to provide hospice care.
• Retaining small a staff for the hospice population size, which means less quality care for each patient.
• Claiming that certain patients qualify for hospice care when they actually do not.
It is interesting to note that after the after government started looking into the growing number of hospice patients in the US, Hospice of the Comforter discharged over 130 of them claiming their conditions were no longer terminal. A first investigation involving government auditors found that the hospice’s error rate was 18%–the government allows a 15% error rate. According to Stone, another, based on a more rigorous examination in January 2010, Medicare officials are now thinking that 77% of the cases it investigated, the Florida hospice company was not properly billing the government.
If the government were to win the hospice Medicare fraud case against Hospice of the Comforter the could be ordered to pay up to $33 million–three times what Stone, as the whistleblower, was contending. Stone would be entitled to up to 25% of what is recovered. The DOJ has 120 days to refile the complaint and Stone will serve as a witness.
Feds join whistleblower lawsuit against Hospice of the Comforter, Orlando Sentinel, August 28, 2012
Hospice of the Comforter faces federal lawsuit over Medicare charges, WFTV, August 29, 2012