Home Health & Hospice Week

The massive Merida Group case gets even more airtime.

Hospices get their fair share of scrutiny in the latest Health Care Fraud and Abuse Control Program Report too.

Hospice fraud cases from 2021 highlighted in the report include:

In Texas: The CEO of a group of hospice and home health entities “was sentenced to 15 years in prison in connection with an over $150.0 million fraud scheme that was one of the first criminal hospice fraud cases tried to a verdict,” the HHS Office of Inspector General and the Department of Justice say in their joint report. The defendants enrolled patients who did not have a six-month terminal prognosis; billed for fraudulent services; and manufactured false and fictitious records and produced them to a federal grand jury, the report says. Further, the defendants used the fraud proceeds to buy luxury vehicles including a Porsche; designer clothing; premium season tickets to see the San Antonio Spurs; and “exclusive real estate,” the OIG and DOJ relate. The defendants also lied to federal agents and engaged in other coverup activities. The owner was sentenced to 20 years in prison and two other co-conspirators have pled guilty and are awaiting sentencing. (See more details of the case in HCW by AAPC, Vol. 30, No. 16.)

Also in Texas: Allstate Hospice and Verge Home Care and their two founders agreed to jointly pay over $1.8 million to resolve allegations that they paid kickbacks to referring physicians via sham medical director payments and dividends for agency ownership. (See more details in HCW by AAPC, Vol. 30, No. 8.)

In California: The administrator of a Southern California hospice was convicted of charges that he paid kickbacks to patient recruiters for referrals and overruled clinical staff determinations that patients weren’t eligible for the hospice benefit, the report notes. The owner pled guilty to the scheme and was sentenced to 30 months in prison and restitution of over $2.1 million.