The United States has partially intervened in two qui tam lawsuits by three whistleblowers alleging violations of the False Claims Act by Evercare Hospice and Palliative Care (“Evercare”) now known as Optum Palliative and Hospice Care. One of the qui tam lawsuits also names UnitedHealth Group, Inc., a parent company of Evercare.
According to the whistleblowers, Evercare submitted claims to government healthcare programs for hospice benefits for patients who did not meet the criteria for hospice care. Hospice care is intended for patients with a life expectancy of six months or less who elect palliative care. Palliative care provides symptomatic and/or pain relief, it is not designed to cure or treat an illness.
Three former Evercare employees, Sharlene Rice, Terry Lee Fowler, and Lyssa Towl, filed whistleblower complaints in Colorado under the qui tam provisions of the False Claims Act alleging that Evercare management pressured employees and medical personnel to admit patients who did not have life expectancies of six months or less to hospice care. According to the government, submissions to government healthcare programs, such as Medicare, for hospice care provided to patients who were not terminally ill, were false claims in violation of the False Claims Act.
According to the whistleblowers, between 2008 and 2010, up to 25% of Evercare’s hospice patients at any given time did not meet the Medicare eligibility requirements to receive hospice care. One of the whistleblowers, Lyssa Towl, claims that she was fired for discharging patients who were ineligible for hospice care. Terry Lee Fowler claims she was put on a corrective action plan for questing Evercare’s methods.
The False Claims Act permits citizens to bring actions on behalf of the government to recover funds that were paid as a result of fraud on the government. The government may elect to intervene in the lawsuits as it has done in these cases. If any money is ultimately recovered in the lawsuits, the whistleblowers may be entitled to share in a percentage of the proceeds in accordance with the qui tam provisions of the False Claims Act.
If you know of government fraud, you can get more information at Do I Have a Case?