May 9, 2013

Turning up the HEAT on Hospice Care Providers

Alert | Corporate Compliance Alert

The Department of Justice (DOJ) very recently charged the nation's largest for-profit hospice chain, Vitas Innovative Hospice Care (Vitas), which is headquartered in Miami, with inappropriately admitting patients and billing Medicare for unnecessary crisis care in violation of the False Claims Act, highlighting the agency's ongoing battle to combat fraud in the hospice industry.

The complaint against Vitas further alleged that Vitas paid employees bonuses tied to the number of patients they enrolled for crisis care services when those services were not reasonably medically necessary. The compliant further alleged that Vitas used “aggressive marketing tactics and expected their employees to increase the number of crisis care claims submitted to Medicare, without regard to whether the crisis care services were appropriate.”Finally, the complaint alleged that the company's marketing department intentionally misled patients into believing they qualified for "intensive comfort care" services, a level of care covered by Medicare only in the case of a short-term crisis and acute medical symptoms, and "to believe that the Medicare hospice benefit would routinely cover around the clock care for hospice patients."

The lawsuit is further evidence of the DOJ’s commitment to making hospice care an essential component of its Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, announced by Attorney General Eric Holder and Health and Human Services (HHS) Secretary Katherine Sebelius in May of 2009, and is the latest in a series of actions by the DOJ against a number of hospices for the submission of inaccurate or fraudulent claims to Medicare....

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