Home Health & Hospice Week

Plus: Hospice medical director gets 5 years in prison, $15 million in restitution.

Terminal illness is once again the crux of multiple fraud cases involving hospices.

This time, the Department of Justice says Salt Lake City-based “Summit Hospice knowingly submitted false claims for payment to Medicare and Medicaid between October 1, 2018, and September 7, 2021,” according to a release. “Summit Hospice was billing for services that were not medically necessary, because the patients’ records lacked documentation of a terminal illness to qualify for services,” the Justice Department alleges.

“Summit Hospice denies the allegations,” the DOJ adds. But the company has agreed to pay $1 million to settle the charges.

“Providers who focus on personal financial gain rather than providing medically necessary, high-quality care to their patients undermine the integrity of these services,” Curt L. Muller, OIG Special Agent in Charge, says in the release. “HHS-OIG will continue to work with our federal and state partners to ensure that hospice providers are giving their patients the care and comfort they need,” Muller adds.

Meanwhile, in Mississippi, a physician who was a medical director for multiple hospices in Northern Mississippi has been sentenced to five years in prison for Medicare fraud. Dr. Scott Nelson must also repay $15 million to Medicare.

Last year, a federal jury convicted Nelson of healthcare fraud. From 2009 through 2014, Nelson served as medical director for as many as 14 hospice providers and received about $442,000 in medical director fees from those hospices, the Department of Justice says in a release.

Hospices would routinely transport prospective patients to Nelson’s office, where he would see them and refer them for hospice. “In almost all cases, the patients had no idea they were being placed on hospice and multiple patients testified at trial that Dr. Nelson did not explain hospice to them and did not tell them he was referring them to hospice care,” the DOJ says.

Nelson also certified patients as terminally ill when they weren’t, and “robosigned” numerous medical records supporting medically unnecessary hospice services, the DOJ says. Hospices received more than $15 million from Medicare based on Nelson’s referrals and certifications. Four of the associated hospice owners had been convicted of healthcare fraud prior to Nelson’s trial.