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Feds Intervene in False Claims Case Against UnitedHealth Group

Federal officials have intervened against defendants in two whistleblower lawsuits in federal court in Colorado alleging Evercare Hospice and Palliative Care (Evercare) submitted false claims for the Medicare hospice benefit.

Evercare is now known as Optum Palliative and Hospice Care, which provides hospice services across the United States.

One of the suits names Evercare’s parent companies, including UnitedHealth Group.

The Medicare hospice benefit is available for patients who elect palliative care (medical care focused on providing patients with relief from pain, symptoms or stress) for a terminal illness, and have a life expectancy of six months or less if their illness runs its normal course.

When a Medicare patient is admitted to hospice, that individual is no longer entitled to Medicare coverage for care designed to cure his or her illness.

One lawsuit — filed by Terry Lee Fowler and Lyssa Towl — former employees of Evercare — alleges that defendants violated the False Claims Act by knowingly submitting false claims for hospice benefits for patients who did not have a life expectancy of six months or less.

The complaints include allegations that management pressured employees and physicians to admit and retain patients who were not terminally ill and challenged or disregarded physicians’ decisions that patients should be discharged.

According to the lawsuit, the companies “targeted for admission ineligible elderly patients with conditions like debility, dementia, Alzheimer’s and cardiac or pulmonary irregularities that while serious were not likely to lead to the death of the patient within six months, thus allowing the defendants to keep these types of patients on their hospice census for more than six months, if not several years.”

The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the United States for the submission of false claims to the government.

The private plaintiffs are entitled to receive a share of any funds recovered through the lawsuit.

The False Claims Act authorizes the United States to intervene in a whistleblower lawsuit and take over primary responsibility for litigating it as the United States has done here, and permits the government to recover three times its damages plus civil penalties.  The United States has notified the court that it intends to file its own complaint.

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