A home healthcare and hospice provider agreed to pay $3.85 million to resolve FCA allegations that it knowingly submitted false claims to Medicare for (1) patients who did not qualify or were not accurately certified for the benefit; (2) services not reasonable or considered medically necessary; and (3) services not provided or provided by untrained staff. The settlement is based on the provider’s ability to pay.
A hospice provider, its owners and managers agreed to collectively pay $1.4 million to resolve FCA allegations that they entered into kickback arrangements, including monthly stipends and signing bonuses, with medical directors in exchange for patient referrals, in violation of the AKS.
A group of hospice providers agreed to pay $4.2 million to resolve FCA allegations that they knowingly submitted false claims and retained the overpayments related to the care of hospice patients who were not eligible for the benefit because they were not terminally ill. The parties also improperly concealed the overpayments of these claims.
A hospice company agreed to pay $48,830.70 to resolve allegations that it billed hospice services to Medicare for beneficiaries who were not terminally ill and which were not medically necessary.
A hospice provider agreed to pay more than $1 million to resolve allegations it billed Medicare and Medicaid for care that was not justified by the patients' medical records and therefore not considered medically necessary.
Hospice provider agreed to pay more than $990,000 to resolve FCA allegations that it submitted claims to Medicare for hospice services provided to patients who were not eligible or qualified to receive the hospice benefit.
Hospice chain agreed to pay $5.5 million to resolve FCA allegations that it billed Medicare for hospice services provided to patients with Alzheimer’s or dementia who were not terminally ill.
Hospice provider, home health provider and their owners agreed to pay more than $1.8 million to resolve FCA allegations that they submitted claims to Medicare that were tainted by improper compensation arrangements and referral relationships, in violation of the AKS and Stark Law. The providers allegedly paid referral sources above FMV for medical directorship services and provided physicians other gifts and benefits, including travel and sporting event tickets. Allstate also sold interests in the company to five different physicians which ultimately netted them substantial quarterly dividends.
A hospice provider agreed to pay more than $4.8 million to settle allegations that it billed Medicare and Medicaid for services at heightened levels of care when the patients receiving the services did not qualify for those levels.
A hospice provider agreed to pay $3.2 million to settle allegations that it submitted claims to Medicare for patients who were not terminally ill and submitted claims to Medicare, Medicaid, and TRICARE for inpatient hospice care when such a level of care was unnecessary.
A hospice provider and two of its senior executives agreed to pay $1.75 million to settle claims that it submitted claims for hospice benefits for patients who were not terminally ill. The company also submitted claims for services provided by a physician who was not actually a provider at the hospice, but instead was paid to be a "back up" medical director.
A hospice provider agreed to pay $1 million to settle allegations that it submitted claims to Medicare for patients who were not terminally ill and thus, not eligible for the Medicare hospice benefit.
A hospice provider agreed to pay $3.1 million to resolve allegations that it billed Medicare for hospice services provided to patients who did not meet hospice eligibility guidelines.
A hospice provider agreed to pay almost $6 million to settle allegations that it submitted Medicare claims for hospice care that was not medically necessary or for which required documentation was lacking.
Hospice service providers agreed to pay $2.5 million to settle allegations that they submitted Medicare claims for patients who were not eligible for the services.
A long-term care provider agreed to pay $10.3 million to resolve state and federal FCA allegations. It is alleged Centerlight submitted fraudulent requests to New York’s Medicaid program for monthly premiums and failed to repay Medicaid for falsely-obtained payments. New York’s Medicaid program will receive $6.36 million in restitution and penalties from the total settlement payment.
A hospice company and its CEO agreed to pay $1.24 million to resolve allegations the company fraudulently billed Medicare and Medicaid for hospice services for patients who were ineligible for hospice because they did not have a life expectancy prognosis of six months or less.
A hospice company agreed to pay more than $5 million to settle allegations that it submitted claims to Medicare for hospice services that were not supported with adequate documentation, resulting in reimbursements being received for hospice care for longer terms than appropriate.
A hospice services provider agreed to pay $75 million to resolve allegations that it submitted claims to Medicare for hospice services provided to patients who were not eligible for hospice services and provided employees with bonuses based on the number of patients receiving hospice services, regardless of patient eligibility. The settlement also covers claims that the company submitted claims for services provided at the highest rate when the services required were at lower rates.
A hospice group agreed to pay $2.4 million to resolve FCA allegations that it paid a medical director for referrals and also entered into sham contracts with associate medical directors in exchange for referrals. The company then submitted claims to Medicare and Medicaid for services provided to the referred patients.
A for-profit hospice provider agreed to pay $2 million to resolve FCA allegations that it admitted patients who did not qualify for hospice care and provided unneeded services to them on the basis of a medically unjustified diagnosis of “debility.”
The owners of a now-defunct hospice facility agreed to turn over $8 million in assets to resolve FCA allegations that through their business, they billed Medicare for services supposedly provided to patients who were not eligible for hospice services.
Several hospice companies agreed to pay $12.21 million to resolve FCA allegations that they submitted claims to Medicare and Texas Medicaid that were rendered false as a result of the payment of kickbacks by the hospices, their owners and employees, and others.
A hospice provider and related entities agreed to pay $200,000 to resolve FCA allegations that it contributed more than $15,000 to a cancer charity established by a physician, in exchange for the referral 23 patients for hospice care, in violation of the Anti-Kickback Statute.
A hospice provider agreed to pay $18 million to resolve FCA allegations that it claimed Medicare reimbursement for hospice care for patients who were not eligible for such care because they were not terminally ill and because their medical records did not support that they were terminally ill. The government alleged that the provider's business practices were designed to maximize the number of patients for whom it could bill Medicare without regard to whether the patients were eligible for and needed hospice.
A hospice service provider agreed to pay $2.5 million to resolve FCA allegations stemming from a government investigation which purportedly uncovered approximately $1.5 million in questionable billings submitted to Medicare Part A. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG.
A hospice provider agreed to pay $1.08 million to resolve FCA allegations that it improperly billed for hospice services because, during some or all of the period that certain patients were receiving hospice care, the patients did not have a medical prognosis of six months or less if their illnesses ran their normal course.
A hospice provider agreed to pay $3.02 million to resolve FCA allegations that it billed Medicare and Medicaid for medically unnecessary hospice care for at least 52 patients who had lengths of stay greater than 1,000 days. The government asserted that the documentation for these patients failed to support the length of hospice services, failed to document basic patient characteristics and included unsigned records or records signed with inconsistent practitioner information. Certain patients were allegedly admitted to the hospice because their spouse was in hospice care; other patients purportedly were approved to take multiple, lengthy, out-of-state trips during a five-year period.
A hospice company and its founder and former president agreed to pay $2.2 million to resolve FCA allegations that it billed Medicare for hospice services for patients that were ineligible to receive such services. As part of the settlement, the company agreed to enter into a five-year CIA with HHS-OIG, and its owner agreed to a five-year exclusion from federal healthcare programs.
A hospice provider and its affiliates agreed to pay $3 million to resolve FCA allegations that they billed Medicare for hospice patients who were not terminally ill. The government asserted that its business practices contributed to its submission of false claims, including failing to properly train staff and medical directors on the hospice eligibility criteria, establishing aggressive targets to recruit and enroll patients, and failing to adequately oversee the hospice.
A group of thirteen hospice entities and its majority owner and manager agreed to pay more than $5.86 million to resolve FCA allegations that they submitted false claims for delivery of continuous home care hospice services to patients when there was no crisis. According to the government, the hospice was identified as an outlier in billing for these services, the rate for which is the highest daily rate a hospice can bill Medicare. As part of the settlement, the organization agreed to enter into a five-year CIA with HHS-OIG.
A hospice provider agreed to pay more than $10.1 million to resolve FCA allegations that it overbilled for hospice services by billing for general inpatient care when medical records supported only the necessity of routine care.
A hospice company and several related entities agreed to pay $4 million to resolve FCA allegations they fraudulently certified patients as hospice-eligible even though the patients did not have a terminal prognosis of six months or less. As part of the settlement, each of the entities agreed to enter into a five-year CIA with HHS-OIG.
Two related hospice providers agreed to pay $4.9 million to the United States and $1.6 million to New York to resolve FCA allegations that they sought payment from Medicare and Medicaid for hospice nursing services that were not delivered according to several regulatory guidelines governing the provision of reimbursable hospice services. Specifically, a provider failed to treat patients according to an individualized plan of care, meet the needs of certain patients, make nursing services available 24/7 as required and maintain adequate clinical records, while the other entity failed to provide sufficient oversight through its compliance audits. As part of the settlement, they agreed to enter into five-year CIAs with HHS-OIG.
A hospice provider and an affiliate agreed to pay $581,504 to settle FCA allegations that they billed Medicare for hospice services for patients who were ineligible for hospice care under Medicare regulations.
A hospice provider agreed to pay $3.9 million to resolve FCA allegations that it billed federal and state healthcare programs for hospice services provided to patients who were not terminally ill under Medicare and Medicaid regulations. This settlement was announced in March 2014.
A hospice provider agreed to pay $3 million to resolve FCA allegations that it billed Medicare for patients that were not terminally ill as a result of instructing its staff to admit patients without regard to their Medicare eligibility, falsifying medical records for ineligible patients, employing field nurses without hospice training, delaying discharge for patients when they become ineligible for the Medicare hospice benefit, and implementing procedures to limit physicians’ roles in examining whether a patient is terminally ill. As part of the agreement, the organization entered into a five-year CIA with HHS-OIG.
A hospice provider agreed to pay $1 million to resolve FCA allegations that it submitted claims to Medicare for ineligible hospice services provided to patients who did not need end-of-life care or for whom the hospice billed at a higher reimbursement rate than it was entitled. The company also purportedly provided kickbacks through free services to skilled nursing facilities in exchange for patient referrals. As part of the agreement, the hospice entered into a five-year CIA with HHS-OIG.
Two hospice companies and their parent company agreed to pay $12 million to resolve FCA allegations that they submitted claims to Medicare for ineligible hospice services provided to patients who did not need end of life care or for whom the hospice billed at a higher reimbursement rate than it was entitled. As a part of the settlement, the parent organization entered into a CIA with HHS-OIG which provides for procedures and reviews to be put in place to avoid and promptly detect similar conduct.
A hospice company and its CEOand owner agreed to pay $1.3 million to settle FCA allegations that the company submitted bills to Medicare for medically unnecessary services because beneficiaries were ineligible for hospice care because they did not have a terminal prognosis of six months or less.
A hospice provider agreed to pay $555,572 to settle FCA allegations that it submitted bills to the federal government for medically unnecessary services because patients did not qualify for the second highest level of hospice reimbursement – general inpatient care – because the patients did not meet the medical necessity requirement of a need for pain control or acute or chronic system management that could not be managed in another setting.
A hospice provider and its parent company agreed to pay $6.1 million to resolve FCA allegations that they billed federal programs for ineligible hospice services because patients did not have a medical prognosis of six months or less, and improper delays in discharges and misleading documentation resulting from employee payment based on patient census levels.
A hospice provider agreed to pay $25 million to resolve allegations that it submitted false claims to federal programs for medically unnecessary continuous home care services billed at a higher rate than routine care services. As a result, the company entered into a CIA with HHS-OIG.
