Hospice agrees to settle false-claims allegation

HUDSON - Hernando-Pasco Hospice has agreed to pay $1 million to resolve allegations that it submitted false claims to the Medicare and Medicaid programs in an effort to be reimbursed for patients who didn't need hospice care, the U.S. Attorney's Office in Tampa reported.

The hospice also allegedly billed the federal government at higher reimbursement rates than it was entitled to receive, and provided illegal kickbacks by giving free services to skilled nursing facilities in exchange for patient referrals, the U.S. Attorney's Office said.

"The hospice industry provides medical care to our most vulnerable citizens," A. Lee Bentley III, acting U.S. attorney for the Middle District of Florida, said in a prepared statement. "This settlement should send a message to providers that misconduct of this kind will not be tolerated."

Despite the settlement, the U.S. Attorney's Office said the claims against the hospice were allegations only and there was no determination of liability.

Robin Kocher, director of communications for the hospice, said many of the allegations were "absolutely false," but the hospice agreed to the settlement after deciding it was in the best interests of its patients and their families to avoid the expense and time of a court case.

The allegations arose from a lawsuit filed by two former hospice employees, Heather Numbers and Greg Davis, under the whistleblower provisions of the federal False Claims Act. That act allows private citizens to bring suit on behalf of the U.S. government for false claims and share in any recovery. Number and Davis will share $250,000, the U.S. Attorney's Office said.

Hernando-Pasco Hospice reportedly submitted its false Medicare and Medicaid claims between Jan. 1, 2005, and Dec. 31, 2010. The reimbursements for hospice services are supposed to be for people expected to live six months or less and who no longer are receiving care to cure their illnesses, the U.S. Attorney's Office said.

The claim against the hospice said that was not the case with many of the patients for whom Hernando-Pasco Hospice sought reimbursement.

Instead, the hospice caused its staff to admit ineligible patients in order to meet target goals set by management, and adopted procedures to delay and discourage staff from discharging patients who were not appropriate for hospice services, the U.S. Attorney's Office reported.

The hospice also instructed staff to place false or misleading statements in patients' medical records to make them appear eligible, and failed to implement an adequate compliance program that might have corrected the problems, authorities said.

The hospice won't pay the $1 million all at once. The settlement calls for quarterly payments of $50,000 over five years.

As part of the settlement, the hospice also must put in place procedures and reviews to avoid and promptly detect similar activities in the future.

Hernando-Pasco Hospice reported it has already taken steps toward that goal. The not-for-profit agency said it appointed a full-time compliance officer, worked with a consulting firm with special expertise in regulatory and compliance issues specific to hospices, and established an agency-compliance committee that meets monthly.

The hospice reported that it also hired three full-time registered nurses to review and monitor all admission, re-certification and discharge documentation, and implemented advanced training for administrators and staff that was kicked off with a compliance "boot camp" and staff in-service training.