The Justice Department has joined in a whistleblower lawsuit against Hospice of the Comforter Inc. (HOTCI), alleging false Medicare billings.
HOTCI provides hospice services to patients residing in the vicinity of Orlando, Florida.
The Medicare hospice benefit is available for patients who elect palliative treatment — medical care focused on providing patients with relief from pain and stress — for a terminal illness, and have a life expectancy of six months or less if their disease runs its normal course.
When an individual is admitted to a hospice facility, that individual is no longer entitled to receive curative care — services designed to cure his or her illness.
The whistleblower lawsuit was originally filed by HOTCI’s former vice-president of finance, Douglas Stone.
Stone alleged that HOTCI knowingly submitted false claims to Medicare for hospice care for patients who were not terminally ill.
Stone alleged that HOTCI’s chief executive officer verbally instructed HOTCI employees to admit Medicare recipients for hospice care even where there had not yet been a determination that they were eligible for the hospice benefit.
The lawsuit also alleges that, after being notified that it would be audited by its Medicare contractor, HOTCI formed an internal committee to review the eligibility of its Medicare patients and discharged at least 150 patients in 2009-2010 as being ineligible for the Medicare hospice benefit.
“The hospice benefit is intended only for people who qualify for and require such care,” said the Justice Department’s Stuart F. Delery.
“We will continue to protect this important component of the Medicare program by ensuring that entities providing hospice care are only treating, and billing for, qualified patients.”