Hospice settles FCA case for $3M before it gets a terminal diagnosis

Guardian Hospice of Georgia LLC, Guardian Home Care Holdings Inc., and AccentCare Inc. (Guardian) agreed to settle False Claims Act (FCA) (31 U.S.C. §3729 et seq.) allegations by paying $3 million. According to a Department of Justice press release, the settlement will resolve allegations that Guardian knowingly submitted false claims to the Medicare program for hospice patients who did not qualify for hospice care because they were not terminally ill.

Hospice

The Medicare hospice benefit is available to provide palliative care for beneficiaries that have a terminal illness with a life expectancy of six months or less. Prior to billing Medicare, hospice providers must comply with requirements to determine that the beneficiary foregoing curative care is in need of end-of-life care. Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, said “the Medicare hospice benefit is intended to provide comfort and care to patients nearing the end of life.” He continued by saying that the DOJ “will continue to aggressively pursue companies that abuse the Medicare hospice benefit to improperly inflate their profits.”

Fraud

The government alleged that Guardian’s business practices contributed to the hospice provider’s submission of claims for patients who did not have a terminal illness of six months or less. Specifically, the government alleged that the hospice provider failed to properly train its staff and medical directors on hospice eligibility requirements, set aggressive patient recruitment targets, and failed to oversee hospice activities. The allegations arose when two former employees of Guardian filed a qui tam action under the FCA. The two whistleblowers will receive approximately $510,000 as their share of the settlement.