Government Intervenes in Hospice Care Whistleblower Cases Alleging False Claims By Tod Aronovitz | 09/17/14 | 0 Comment

The Justice Department announced that the United States has partially intervened in two hospice care whistleblower lawsuits that accuse Evercare Hospice and Palliative Care of submitting false claims for the Medicare hospice benefit. Colorado-based Evercare—which is now known as Optum Palliative and Hospice Care—provides hospice services across the country. One of the suits also names Evercare’s parent companies, including UnitedHealth Group Inc.

Central to the allegations is the Medicare hospice benefit. This benefit allows patients, who have a terminal illness with a life expectancy of six months or less, to elect palliative care for relief from pain, symptoms or stress. Once a Medicare patient is admitted to hospice, that patient may no longer receive Medicare coverage for care that would cure the illness.

Filed by former employees, the hospice care whistleblowers contend that Evercare knowingly submitted false claims for hospice benefits for patients whose life expectancies did not meet the 6-month-or-less requirement, violating the False Claims Act.  The plaintiffs also claim that management pressured employees and physicians to admit and retain patients who were not terminally ill, in addition to challenging or disregarding physicians’ orders for discharging patients.

“Hospice care plays a critical role in our healthcare system, providing for end-of-life care as opposed to curative life care,” said U.S. Attorney John Walsh for the District of Colorado.  “When companies systematically overbill Medicare by keeping people in hospice when they don’t need to be there, it jeopardizes this important benefit for others under the program.”

The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, one of the government’s most powerful tools in combating fraud. As a result of the FCA provision, which enables private citizens to sue on behalf of the United States and receive a share of any funds recovered through the lawsuit, the Justice Department has recovered a total of more than $22.4 billion through False Claims Act cases since January 2009, with more than $14.2 billion of that amount recovered in cases involving fraud against federal health care programs.

The False Claims Act also authorizes the government to intervene and take over primary responsibility for litigating the whistleblower lawsuit, as the United States has done here, and permits the government to recover three times its damages plus civil penalties.  The United States has notified the court that it intends to file its own complaint.

The lawsuits are consolidated and captioned United States ex rel. Fowler and Towl v. Evercare Hospice, Inc., et al., No. 11-cv-00642 (D. Colo.); United States ex rel. Rice v. Evercare Hospice, Inc., No. 14-cv-01647 (D. Colo.).

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect up to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.