Hospice accused of treating ineligible patients agrees to $1.2M False Claims settlement

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A for-profit hospice company and its owner agreed to pay $1.2 million to resolve allegations that the company fraudulently billed Medicare and Medicaid for hospice services.

The settlement resolves two whistleblower lawsuits filed in federal court in Pittsburgh against Horizons Hospice and owner John C. Rezk.

U. S. Attorney Scott W. Brady last week said Horizon was accused of submitting false claims to Medicare and Medicaid for patients not qualified for hospice because they did not have a prognosis of living six months or less. Officials also said the company falsified records to support the false claims.

In 2016, Horizon's former manager was sentenced to 15 months in prison for healthcare fraud. She was convicted of admitting patients without a terminal illness so the company could falsely bill Medicare and Medicaid for end-of-life care. The medical director in Pittsburgh also pleaded guilty to participating in the fraud and was sentenced to 33 months in prison, in conjunction with a longer sentence for prescribing oxycodone to patients who did not need them.

The Pittsburgh Tribune-Review could not reach Rezk for comment, but an attorney said the company, now operating as 365 Hospice, had cooperated fully with the investigation.

“We are pleased to bring this matter to a successful conclusion,” he told the newspaper.

The case was investigated by the Office of Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigation.