Hospice fraud investigations are on the rise. Recently, the Department of Justice (DOJ), the United States Department of Health and Human Services (DHHS), the Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), the Medicaid Fraud Control Unit, and other state and federal agencies have all intensified their efforts to prosecute hospices for alleged fraud throughout the United States.
Understanding Hospice Fraud
Typical Hospice Fraud Allegations
In a typical case, the government alleges that hospice owners and staff members are involved in a conspiracy to defraud the United States by seeking reimbursement for medical services that are either: (i) medically unnecessary, or (ii) not provided at all. Most cases involve reimbursement claims submitted under Medicare or Medicaid.
Recent Examples of Criminal Cases
In one recent case, the U.S. Attorney’s Office for the Western District of Pennsylvania sought a woman’s indictment on five counts of healthcare fraud based upon her alleged involvement in hospice fraud. In another case, a hospice owner received a 15-year prison sentence and was ordered to pay $16.2 million in restitution after being found guilty of Medicare fraud. This individual had billed thousands of fraudulent claims and had paid nurses and doctors to attest to the medical necessity of billed-for services.
Avoiding Criminal Charges
In criminal cases, healthcare fraud carries a potential sentence of ten years in prison for each individual count. But, not all hospice fraud investigations are criminal in nature. Some cases are civil, and instead of seeking prison time, the prosecutor demands reimbursement of overpaid amounts. For example, in one recent civil case, a New York hospice owner agreed to pay approximately $6 million to settle allegations of Medicare and Medicaid fraud. The government also sought the implementation of a compliance program and other monitoring to ensure that billing errors would not continue going forward.
Warning Signs of an Investigation
Whether a case is criminal or civil is a critical question. As a general rule, the sooner you consult with an experienced healthcare fraud defense attorney, the better your chances of avoiding criminal charges. If your business experiences a payment stop or you see other signs of possible government activity, you should contact our defense team right away to get ahead of the investigation.
Request a Free Case Evaluation at The Criminal Defense Firm
If you believe you are under investigation for hospice fraud, call the former federal healthcare prosecutors and experienced defense attorneys of The Criminal Defense Firm right away. To discuss your options and plan your next move in confidence, call 866-603-4540 or request a free case evaluation online now.
Brian Kuester offers his extensive experience to counsel companies and individuals under civil or criminal government investigation. When resolution requires litigation, clients choose Mr. Kuester’s proven court and litigation experience.