Whistleblowers May Prove Vital as Government Targets Hospice Fraud

04/11/2013 // Whistleblower Law Firm (Press Release) // Jeffrey F. Keller // (press release)

The message to hospices was clear: The government knows there is fraud in the industry and is going to be watching closely. The government may have some help in the process, too: whistleblowers who know of improper behavior and speak out about it.

In its Work Plan for 2013, the U.S. Department of Health and Human Services noted that focusing on improper payments would be a priority this year — and one of the frauds it will be looking for, and taking action against, relates to hospices. Specifically: hospice marketing practices and financial relationships with nursing facilities. The Work Plan, released by HHS’s Office of the Inspector General, cites a recent OIG report that found that 82 percent of hospice claims for beneficiaries in nursing homes did not meet Medicare coverage requirements. It also noted that MedPAC, an independent congressional agency that advises Congress on issues involving Medicare, found that hospices and nursing facilities may be involved in inappropriate enrollment and compensation.

For more than a century and a half — but particularly in the past few decades — federal and state whistleblower laws have proven a potent weapon in the fight to reduce, and remedy, fraud against the government. Indeed, the gold standard of U.S. whistleblower laws, the False Claims Act, has led to the recovery of more than $30 billion since it was significantly modified in the mid-1980s. By enabling whistleblowers to share in any ultimate recovery, the False Claims Act provides a powerful incentive for those with ‘inside’ knowledge of wrongdoing to speak out about it.

Whistleblowers using the False Claims Act and other statutes have already thrown back the covers on fraud in the financial services, pharmaceutical, healthcare, and defense industries,” says Jeffrey F. Keller, a founding partner at Keller Grover, a nationally recognized labor and employment law firm, and a veteran whistleblower lawyer whose firm has offices in Los Angeles and San Francisco. “By directing the government to improper marketing and Medicare billing practices by hospices, they can spur government efforts to check this increasingly worrisome fraud, as well.”

One such whistleblower helped the government obtain a $12 million settlement against an Arizona hospice company in a false billing case. The whistleblower, a former employee of the company, alleged that hospice workers submitted false Medicare claims between 2002 and 2010 for unnecessary care, or for care provided to ineligible residents. For speaking out and steering the government to those improper activities, the whistleblower will receive $1.8 million of the settlement money.

“Once again we are seeing the increasingly important role whistleblowers are playing in combating fraud against the government,” says Keller who was not involved in the case. “Whistleblowers show us where bad behavior lurks, so we can fight it, and recoup taxpayer dollars. The statutes reward whistleblowers for this, but in the end, they reward all of us, by stamping out fraud.”

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