The federal government says hospice fraud costs taxpayers hundreds of millions of dollars. An Action News Jax Investigation has uncovered hospices accused of fraud are only getting a slap on the wrist.
“My signature was on paperwork that I didn’t sign,” said Jacksonville hospice whistleblower Dr. John Simons.
That was one of the first red flags for Simons. He’s a former medical director at Haven Hospice and Hospice of the Treasure Coast.
Hospice is where people go for end of life care, but Simons said he saw a pattern of hospices taking on patients with plenty of life left to live, billing Medicare hundreds of dollars a day.
“There was a CEO down at one point who basically just told us to just do it and shut up. We didn’t have an option,” said Simons. Simons became a whistleblower for the federal government.
The U.S. Attorney's Office hit both Haven Hospice and Treasure Coast with False Claims Act Lawsuits.
Both hospices settled last year.
That’s not the end of the story. “The penalties don’t meet the crime, if you will,” said Simons.
The government accused Haven Hospice of defrauding taxpayers out of “hundreds of millions,” but Haven only had to pay up about $5 million.
The government accused Treasure Coast – now known as Treasure Health – of defrauding taxpayers out of $72 million. They settled for $2.5 million.
Action News Jax kept digging through federal court records, and found every Florida hospice hit with a False Claims Act lawsuit settled for a fraction of the amount they’re accused of taking fraudulently.
Assistant Special Agent in Charge Brian Martens supervises the Jacksonville and Orlando offices of the U.S. Department of Health and Human Services Office of Inspector General. It’s the federal agency that investigates hospice fraud.
Martens said every Medicare dollar taken fraudulently is a dollar that can’t be used by a dying patient who actually needs it.
He said the money could run out within a decade.
“If your parents are dying or my parents are dying, how do they get the treatment if others have taken that cash?” said Martens.
Action News Jax asked Martens what incentive there is for a hospice to be honest if it could potentially get away with defrauding taxpayers out of hundreds of millions of dollars.
“There is a potential risk that people could be investigated and go to jail,” said Martens. “In a corporate environment, breaking the corporate veil to get to prove something beyond a civil related matter is a difficult thing.”
An Office of Inspector General report last month identified vulnerabilities in the Centers for Medicare & Medicaid Services’ oversight that are putting patients and taxpayers at risk.
The report said the OIG found CMS has no way of penalizing hospices behaving badly, other than cutting off the hospice from the Medicare program.
Action News Jax called every Florida hospice that settled with the government.
None of them wanted to talk, but they asked Florida Hospice & Palliative Care Association President Paul Ledford to do an interview instead.
Action News Jax asked Ledford why the hospices did not want to talk.
“Well, I think most of them view it as sort of a private matter now. They’ve reached a corporate integrity agreement,” said Ledford.
Ledford said False Claims Act lawsuits against hospices more often stem from differences in medical opinions and poor record-keeping than intentional fraud.
“The whistleblowers, invariably, tell a story that’s more dramatic than the facts will bear out,” said Ledford.
Dr. Simons no longer works in hospice care. He was awarded about $1 million as part of the settlements.
Simons said he has little hope that the hospices will change their ways. “The small slap on the wrist -- you know, I think, unfortunately some hospices may continue that behavior,” said Simons.
If you suspect a company is committing health care fraud, you have the power to report it.
Contact U.S. Department of Health and Human Services Office of Inspector General at 1-800-HHS-TIPS (447-8477) or online here.
Cox Media Group