Working With Whistleblowers in the Fight Against Hospice Care Fraud

It takes a very special individual to work in the end-of-life care arena. We have the deepest respect for the men and women who support both patients and their loved ones in the hospice care environment. These professionals offer much more than medical care, they offer emotional support to people facing some of life’s hardest moments. It is out of respect for the vast majority of these workers who are honest and good-hearted and a belief in the importance of the services they offer that our San Francisco-based Medicare fraud law firm is committed to uncovering and redressing cases of hospice care fraud.

Hospice Care Generally
The Eldercare Locator, a program operated by the Administration on Aging, U.S. Department of Health and Human Services (“HHS”), helps connect older Americans and their loved ones with a range of senior services. The website offers a Hospice Care Factsheet which explains that hospice programs help the terminally ill and their families with 24-hour care aimed at making the patient’s final days as comfortable and dignified as possible. In addition to medical services, hospice care offers psychosocial support to patients and their loved ones.

Government Joins Case Alleging Hospice Care Fraud
As the Eldercare Locator Factsheet explains, hospice care is often covered by Medicare and sometimes by Medicaid. This allows eligible individuals to access services they couldn’t afford otherwise. Unfortunately, it also means the problem of Medicare fraud seeps into the hospice care arena.

In an August 2014 press release, the Justice Department announced that the United States government opted to intervene in a whistleblower-filed lawsuit involving allegations that a hospice provider violated the False Claims Act. The hospice benefit is available to Medicare patients who are terminally ill and have a life expectancy of six months or less. The pending lawsuit alleges that Evercare Hospice and Palliative Care (“Evercare”) knowingly submitted Medicare claims for hospice services for patients who did not meet this threshold. Additionally, the complaints allege that company management put pressure on employees to admit and retain ineligible patients and pushed them to ignore physicians who said patients should be discharged.

Discussing the government’s decision to intervene in the complaints originally filed by former Evercare employees, Assistant Attorney General Stuart F. Delery emphasized the desire to protect qualified individuals’ right to end-of-life care. Likewise, the U.S. Attorney for the District of Colorado John Walsh explained “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. We will not tolerate such conduct.” Another official contrasted the desire to care for a terminally ill individual with a desire to boost company profits.

The Role of Whistleblowers and Our Medicare Fraud Law Firm
As with other forms of Medicare fraud, company insiders are usually the people best suited to bring claims involving fraud in the hospice care field. An article on Denver news site Westword explains that the Evercare litigation began with a 2011 suit filed by Lyssa Towl and Terry Lee Fowler, both former Evercare employees. The women provided information that suggests up to half of the company’s hospice patients were not eligible for the service. Like most whistleblowers, both women attempted to comply with the law and raise their concerns internally before filing a False Claims Act suit. Towl alleges she was fired after discharging ineligible patients and Fowler alleges she was placed on a “corrective action plan” after questioning company policy.

The Brod Firm works with whistleblowers to bring suit against perpetrators of hospice care fraud and other types of health care fraud in federal courts nationwide. Together we help the government recover wrongfully allocated funds and bring an end to fraudulent schemes. While whistleblowers are entitled to a substantial reward when False Claims Act allegations lead to a recovery via settlement or verdict, we find that it is a belief in justice and a desire to do right that motivates these individuals, not money. If you have information regarding Medicare fraud, including hospice care fraud in California, Florida, or another jurisdiction, call our office to learn how you can play a part in the fight to end health care fraud.

See Related Blog Posts:
Illegal Kickbacks in Senior Care Arena: A Crime Threatening Patients’ Health and a Nation’s Wallets
Medicare Fraud and the Home Health Care Industry