The federal government has joined a whistleblower complaint that alleges a major hospice company defrauded Medicare.
AseraCare, which is owned by skilled nursing and hospice services provider Golden Living, pressured hospice workers to recruit large numbers of hospice patients, many of whom should not have been put into hospice, according to the whistleblower complaint.
“Defendants routinely fraudulently enroll unqualified patients despite the lack of terminal diagnosis or documentation of terminal illness, ‘dump’ these patients after six months, then replace them with new unqualified patients (often from their nursing home rolls) thus disguising their fraud while increasing their total number of enrollments and the Aggregate Cap amount and while maintaining a high ‘census,’” states the complaint, which was filed in 2009.
AseraCare rewarded providers that met admission goals, and job retention was linked to maintaining census, wrote the U.S. attorney general in the federal complaint. It was filed in December in the U.S. District Court for the Northern District of Alabama.
The company also “allowed admission nurses and not always physicians to make the initial determination of a patient’s eligibility for hospice,” the suit says.
That’s not true, says AseraCare Hospice President and Chief Medical Officer David Friend, M.D.
“Each one of our hospice patients is in our care because two independent physicians have certified his or her eligibility and because the individual has made a decision to focus on care and comfort when a cure is not possible,” said Friend in a statement. He also cited the unpredictable disease patterns of certain terminal illnesses.
The allegations “are without merit,” added AseraCare general counsel David Beck.
The government is asking for statutory damages as well as reimbursement for what it paid out in Medicare costs.
From the February 01, 2012 Issue of McKnight's Long-Term Care News
