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
