The Department of Justice has joined in a whistleblower lawsuit against Hospice of the Comforter (“Hospice”) based in Altamonte Springs, Florida. Hospice serves terminally ill patients in Orange, Seminole and Osceola counties. The whistleblower, Douglas Stone, is the former vice president of finance for Hospice.
According to Stone’s qui tam complaint filed last year, Hospice was improperly billing the federal Medicare program for patients who were not appropriate for hospice care. Stone alleges that a government audit in January 2010 revealed that Hospice submitted improper bills to the government in 77% of the cases audited. Stone also alleges that 133 patients were discharged subsequent to an internal Hospice committee review, which noted that the patients were no longer terminally ill. Stone claims that a short time later, co-founder and CEO of Hospice, Robert Wilson insisted that some of the patients be re-admitted on Medicare’s dime.
Hospice providers are only entitled to Medicare funds for Medicare recipients with a prognosis of six months or less to live. When a Medicare recipient is admitted to hospice care, that patient is no longer entitled to receive medical treatment intended to cure his or her illness. Instead, patients in hospice receive care that is intended to relieve pain, symptoms and the stress of terminal illness.
The whistleblower alleges that Hospice violated the False Claims Act by knowingly overbilling Medicare approximately $11 million for Medicare recipients who were not terminally ill.
The United States has 120 days in which to re-file the False Claims Act complaint and take over as lead complainant. If the case ultimately settles or the United States is successful in proving that Hospice knowingly submitted false claims, Stone will be entitled to a reward of up to 25% of any recovery, under the qui tam provisions of the False Claims Act.