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Case Number: 1:15-cv-00460-MRB
Judge: Michael R. Barrett
Court: United States District Court for the Southern District of Ohio (Hamilton County)
Plaintiff's Attorney: United States Attorney’s Office
Description: Cincinnati, Ohio civil litigation lawyers represented Defendant accused of violating the False Claims ACt by submitting claims to Medicare for non-covered hospice services.
Hospice care is special, end-of-life care intended to comfort terminally ill patients. Patients admitted to hospice care generally stop receiving coverage for traditional medical care designed to cure their terminal condition and instead receive medical care focused on providing them with relief from the symptoms, pain and stress of a terminal illness. Medicare patients are considered to be terminally ill and hospice-eligible when they have a life expectancy of six months or less if their illness runs its normal course.
This settlement resolves allegations that Crossroads Hospice knowingly submitted false claims to Medicare for hospice services for patients who were not terminally ill. According to the settlement agreement, the United States alleged that from Jan. 1, 2012 to Dec. 31, 2014, Crossroads Hospice billed Medicare for hospice care for certain patients with a diagnosis of dementia or Alzheimer’s disease at its Ohio and Tennessee locations who were not terminally ill for at least a portion of the more than three years that the patients received care at these locations.
“Medicare’s hospice benefit provides critical end of life services that focus on palliative rather than curative care,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “This settlement demonstrates our continuing commitment to ensure that hospice services are provided to patients who truly need this care and that patients who are not terminally ill receive appropriate curative care.”
“This office is committed to pursuing providers who put profits ahead of patients,” said Acting U.S. Attorney Vipal J. Patel for the Southern District of Ohio. “We will continue to hold accountable those who abuse federal healthcare programs at the expense of the taxpayers.”
“The Medicare program provides older Americans with access to health,” said Acting U.S. Attorney Joseph C. Murphy Jr. for the Western District of Tennessee. “When frauds like this are committed by serviced providers, it effectively deprives older Americans of health care resources. Our office will continue to take steps to prevent frauds like this from taking place in order to ensure that the Medicare program’s resources are used effectively.”
“The decision to provide hospice services should be prompted by a patient’s terminally ill medical diagnosis and desire for palliative care, not a hospice provider’s desire to boost its profits,” said Special Agent in Charge Lamont Pugh III of U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “Our agency is dedicated to safeguarding both the Medicare program and Medicare patients. This settlement reaffirms HHS-OIG’s commitment to holding accountable providers who knowingly submit false claims to Medicare.”
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Leanne Malone, Jackie Burns and Angela Heck, former employees of Crossroads Hospice, as well as Dr. David Weber, a home health physician in Tennessee. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam cases are: United States ex rel. Leanne Malone et al. v. Carrefour Associates LLC et al., No. 1:15-cv-460 (S.D. Ohio) and United States ex rel. David Weber v. Crossroads Hospice of Tennessee, LLC, No. 2:16-cv-02684 (W.D. Tenn.). Under this settlement, the whistleblowers in the Malone action will receive approximately $1,045,000.
The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section; the U.S. Attorney’s Office for the Southern District of Ohio; and the U.S. Attorney’s Office for the Western District of Tennessee. HHS-OIG assisted in the investigation.
The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
The matter was investigated by Fraud Section Trial Attorney Jonathan Hoerner, Assistant U.S. Attorney Andrew Malek of the Southern District of Ohio and Assistant U.S. Attorney Eileen Kuo of the Western District of Tennessee.
Outcome: Settled for $5.5 million.