Home Health & Hospice Week

Whistleblower case leads to $700,000 settlement.

It's not just owners of shady hospices that the feds are targeting -- it's also the nurses who support them.

Nurses can't just claim innocence by saying they were following instructions from their boss, a newly unsealed indictment against five Philadel-phia-area hospice nurses shows. Last October, Home Care Hospice Inc. owner Matthew Kolo-desh was indicted on Medicare fraud charges in an alleged $9.3 million scam (see Eli's HCW, Vol. XX, No. 38, p. 302).

Now a new indictment names HCH director of professional services and RN Patricia McGill and nurses Natalya Shvets, Giorgi Oqroshidze, Yevgeniya Goltman, and Alexsandr Koptyakov with fraud in the case as well. McGill authorized the nurses to fabricate and falsify documents in support of hospice services for patients who were not eligible for hospice care, or for a higher, more costly level of care than was actually provided to the patients, prosecutors say in a Department of Justice release.

When HCH found out it was being audited in 2007, McGill helped the hospice director in reviewing patient charts, sanctioning false documentation by the nursing staff, and authorizing the alteration of charts, the indictment charges.

McGill also helped initiate a "mass discharge" of 128 patients when the hospice exceeded its cap in 2007, prosecutors allege. Then in spring 2008, HCH brought about 20 percent of the discharged patients back on service.

If convicted, McGill could face more than 11 years in prison and the nurses could face nearly three years of jail time, the DOJ says. The team of prosecutors includes a member of the Organized Crime and Gang Section in the Justice Department's Criminal Division.

Whistleblowers Net $137,000

Meanwhile, Hospice of the Bluegrass Inc. in Lexington, Ky., has agreed to a $685,000 settlement with the HHS Office of Inspector General, according to press reports. And five whistleblowers who filed a qui tam suit sparking the settlement will share in $137,000 as a result.

From 2002 to 2008, Hospice of the Blue-grass submitted claims for ineligible patients, say the U.S. Attorney's Office for the Eastern District of Kentucky and the OIG.

In a statement, Hospice of the Bluegrass says it disagrees with government reviewers about the eligibility of care, and chose to settle after weighing the cost and time it would take to litigate the case, according to press reports.