The government has increased its pursuit of hospice fraud cases throughout the country. Recent examples include a group that agreed to pay $2.5 million to settle a case involving allegation of False Claims Act (FCA) violations, another $1.2 million and still a third agreed to pay over $75 million to resolve similar claims.
Physicians, home health agencies and other health care professionals are increasingly needing to defend themselves against allegations of FCA violations. In 2017, the Department of Justice (DOJ) reports the government pursued 967 criminal health care fraud investigations and an additional 948 civil cases.
What are the accusations? The United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) has made investigations of hospice facilities a prime portion of its work plan. The government often uses the FCA during these investigations to hold health care providers accountable for their allegedly fraudulent practices. In many of these instances, the government has focused on a review of billing practices. The agency is looking for medical practices and health care businesses that are using inappropriate billing practices.
One example that is specific to the hospice industry: fraudulent billing of Medicare and Medicaid for services provided when patients did not meet the six months or less life expectancy prognosis requirement. The government will carefully review records for patients that are wrongfully admitted or improperly retained for hospice services. Additional violations can include the use of kickbacks to increase referrals and wrongly categorizing patients into higher intensive care levels.