Home Health & Hospice Week

Furnishing free care to facility referral sources’ patients is a major no-no.

Are you wondering why CMS, the OIG, DOJ and other enforcement officials are so interested in hospice-SNF relationships? A newly announced False Claims Act settlement may show you.

A whistleblower lawsuit has resulted in a $1 million settlement of False Claims Act charges for Tampa, Fla.-based Hernando-Pasco Hospice Inc. (see related story, this page). Among the many charges leveled by two former social work employees against HPH are providing kickbacks via free nursing and caregiver services to skilled nursing facilities and other referral sources.

"HPH offers to care for [these institutions’ and providers’] patients for free until such time as the patients are referred to hospice," said the qui tam complaint filed by Heather Numbers and Greg Davis, who had longstanding careers as social workers and managers at the company.

For example: "HPH … offers ‘free’ or ‘support’ services to the SNF during the ‘skilled days’ in exchange for the referral once those days are exhausted," the complaint alleged. Medicare pays for the skilled days for 21 days after a qualifying hospital stay. Furthermore, HPH developed a charting system separating "support service" days from regular hospice benefit days to evade detection of the scheme, the whistleblowers contend in the suit.

HPH also offered "support services" to assisted living facilities when patients were on a "break" from hospice care to avoid suspiciously long hospice stays, the complaint claimed.

Watch For Big Dollar Cases Coming Down The Pike

SNFs may be the hottest of the hospice hot button topics, suggests attorney Deborah Randall with Deborah Randall Consulting in Washington, D.C. This settlement has a relatively reasonable value, but keep your eyes peeled for much bigger figures on the horizon. "The ‘big’ case for kickbacks with SNFs and long term care providers is yet to come, and many hospice investigations are under way," Randall warns.

Remember: The Centers for Medicare & Medicaid Services is floating the idea of reducing payment rates for hospice patients in nursing homes, under hospice payment reform, according to CMS’s 2014 hospice payment proposed rule (see Eli’s HCW, Vol. XXII, No. 16). "Hospice patients in a NF/SNF receive more visits than patients at home, though the length of those visits is shorter," CMS discovered in analysis of claims data. "Given the presence of the paid caregiver in the NF/SNF, we would expect that on average, there would be fewer hospice aide services provided to hospice patients in a NF/SNF than to hospice patients at home," CMS says in the rule.