Home Health & Hospice Week

Higher hospice care levels draw scrutiny.

Three employees who worked at a regional hospice chain only “briefly” will rake in a cool million following the hospice’s False Claim Act settlement.

Baton Rouge-based St. Joseph Hospice Entities, which consists of 13 hospice facilities in Mississippi, Louisiana, Texas and Alabama, and Patrick T. Mitchell, its majority owner and manager, have agreed to pay $5.9 million to resolve allegations that it submitted false claims for delivery of continuous home care hospice services to patients who were not entitled to receive CHC-level treatment, the Department of Justice says in a release.

St. Joseph was an outlier in CHC provision, and three former employees — Deedy Diamond, Nichoel Chaisson and Sandra Fairley — who worked briefly for the company brought a qui tam suit about its CHC practices, the DOJ notes. The whistleblowers also alleged that St. Joseph enrolled beneficiaries who were ineligible for hospice due to prognosis, but the government did not take up that issue, according to the Associated Press.

In an email to the AP, Mitchell said billing rules are unclear and the hospice tried to do its best. He also pointed out that CHC saves Medicare money as compared to pricey hospitalizations, and allows patients to stay in their homes comfortably at end of life, the AP says.

“It is sometimes the case that companies and/or individuals will abuse the provision of this service through aggressive marketing practices, thrusting patients into services they really do not need in order to increase the company’s reimbursement rate and its bottom line,” U.S. Attorney Gregory K. Davis says in the release. “We will continue to investigate and root out this and other types of healthcare fraud,” he pledges.

Hospice Nurse Sparks GIP Investigation

CHC may have been St. Joseph’s downfall, but GIP is what triggered a fraud settlement for Alive Hospice Inc. in Nashville. Alive is paying $1.5 million to resolve allegations that it billed Medicare and TennCare for General Inpatient Care that wasn’t necessary, the DOJ says in release.

The suit was initiated by whistleblower Linda Anderson, a former triage nurse for Alive. Anderson will receive more than $263,000 of the settlement, the DOJ says.

“This matter is in no way related to the delivery of patient care, and there has been absolutely no suggestion by the authorities that Alive Hospice provides patients with anything but the highest quality care,” Alive CEO Anna-Gene O’Neal says in a statement. “In fact, the government asserted that Alive Hospice provided a higher level of care to a small number of patients at the end of their lives than it, in hindsight, deemed was necessary. We strongly disagree and maintain that these cases were billed appropriately.”

“Ironically, during the same period of the government’s claims, Alive Hospice provided $6 million in unfunded and underfunded care to patients who could not afford to pay,” O’Neal added. Alive settled only to avoid legal costs, she said. O’Neal said the settlement will not impact the nonprofit’s plans to expand into Rutherford County with a Murfreesboro facility with a planned June 2016 opening, according to The Daily News Journal.

Target: “We are seeing a trend of false claims involving hospice providers,” HHS Office of Inspector General Special Agent in Charge Derrick L. Jackson says in a release. “Providers are overbilling the Medicare program and taking advantage of patients at a particularly vulnerable point in their lives. HHS-OIG will continue to pursue providers who overbill these programs.”

Other hospice fraud cases include:

In Texas: A recent murder case involving hospice employees sounds like an episode of Law & Order. The administrator of Comfort House Services hospice in McAllen is facing charges of murdering an elderly man for his estate. Monica Melissa Patterson was arrested on capital murder charges.

Authorities claim she manipulated 96-year-old Martin Knell into changing his will to leave her a significant portion of his estate, then had him killed by undocumented immigrant and hospice handyman Angel Maria Garza, according to press reports. Knell’s home care worker Celestina Mascorro, one of Patterson’s employees, implicated Patterson and Garza in Knell’s death. Garza was arrested on murder charges. Patterson’s attorney says she will enter a not guilty plea, and points to possible collusion between Mascorro and Knell’s son, who wants the will undone and to receive the sizeable estate, according to The Monitor newspaper. Comfort House issued a statement saying it’s cooperating with authorities and continuing operations as usual.

In Florida: The Florida Agency for Healthcare Administration is conducting a fraud investigation into Beverly Hills-based Hospice of Citrus and the Nature Coast, and Medicaid funds to the facility are suspended during the investigation, reports WCJB TV20 News. While Medicaid reimbursement is suspended, patients are transferring to other hospices such as Haven Hospice in Gainesville, TV20 says.

In Dallas: Hospice-related fraud is not always the hospice’s fault. A woman who stole the identity of an RN and worked at several Dallas-Fort Worth area hospices was sentenced to four years in prison and $233,000 in restitution, the DOJ says. Jada Necole Antoine saw nearly 250 patients at eight different hospice companies from 2009 to 2012, including Heart to Heart Hospice of Texas, Odyssey Healthcare, Community Hospice of Texas, Elysian Hospice, Hospice Pharmacy Solutions, New Century Hospice, Keystone Custom Care Hospice, and Silverado Senior Living Hospice. Antoine plead guilty last December (see Eli’s HCW, Vol. XXIV, No. 8). The hospices submitted about $2.3 million in claims to Medicare for services purportedly performed by Antoine while she was impersonating the victim RN, the FBI said when announcing the charges against Antoine. She received about $107,000 in compensation from the hospices.