The U.S. Department of Justice attorneys say a hospice company should owe $202 million if a jury finds it filed false hospice Medicare reimbursement claims for patients who weren’t really on the verge of dying.
A federal judge has set Aug. 3 as the date to begin the trial of a lawsuit that began when a half dozen employees of AseraCare hospice at operations in Alabama, Wisconsin, and Georgia filed whistleblower cases under the False Claims Act (FCA). The DOJ in January 2012 decided to intervene in court actions.
The DOJ says United States’ is not second-guessing a doctor’s prognosis. A Court document said: “To the contrary, the United States brought this case based on evidence that AseraCare marginalized doctors, systematically pressured its own clinical staff to admit and keep ineligible patients, submitted false hospice claims for patients who were not terminally ill, and was put on notice from internal and external audits and employee complaints that this was occurring.”
DOJ attorneys wrote that they intend to prove AseraCare is liable under the False Claims Act “because it caused non-terminally ill patients to prematurely give up curative or rehabilitative care so that the company could bill Medicare for hospice payments.”
DOJ attorneys on July 2 filed a court document that states AseraCare should pay out $202,481,144 if a jury finds the hospice company violated the False Claims Act. DOJ says Medicare suffered nearly $67.5 million in damages as a result of False Claims Act violations. If the jury awards that amount then the judge is obligated under the law to treble the actual damages and award the U.S. a total of $202,481,144, according to the DOJ’s motion.
More than half of the 233 cases in the random samples should have been deemed ineligible for hospice, the DOJ argued.
AseraCare operates 60 hospice facilities in 19 states, including Alabama, with around 10,000 patient admissions each year, according to court documents. Most AseraCare patients do not have private insurance and are enrolled in the Medicare program, court documents show.
A patient can only be considered for the Medicare hospice benefits if they are diagnosed as terminally ill with a life expectancy of six months or less.