Uncle Sam and state join whistleblower suit over false hospice billing claims

Uncle Sam and Nevada have joined in a whistleblower case alleging Πa for-profit hospice submitted millions of dollars in false claims to Medicare and Medicaid. Whistleblower Joanne Cretney-Tsosie, a clinical manager at Creekside Hospice II, filed a federal lawsuit under seal in 2012. Veneta Lepera, a former clinical manager for the company, filed a federal lawsuit under seal the following year.

The lawsuits were filed under the federal and state False Claims Acts, which allow whistleblowers to inform the government of fraud and share in any recovered money. The lawsuits were combined and became public last week when the government filed its own complaint in the case.

Other defendants in the case are Skilled Healthcare Group Inc., Creekside’s holding company; and Skilled Healthcare LLC, which provides administrative services to Creekside.

According to a Nov. 25 statement from the Justice Department, Medicare and Medicaid hospice benefits are available for patients who have a life expectancy of six months or less if their disease runs its normal course. Medicare or Medicaid patients no longer receive services for curing their illnesses if they are in hospice.

The government’s suit says the defendants knowingly submitted false claims for hospice care for patients who were not terminally ill by directing staff to enroll patients in the hospice program, regardless of the patients’ eligibility for hospice benefits. The suit also says management instructed employees to alter medical records to make it appear that doctors at the hospice visited the patients when they had not, which would ensure reimbursement for Medicare and Medicaid.

Under the False Claims Act, a whistleblower may be entitled to between 15-30% of what the Government recovers as a result of the information rendered.

Jeffrey Newman represents whistleblowers. He does not represent the whistleblowers in this case however.