Hospice Care Fraud | Whistleblowers Serving Justice

Hospice Care Fraud | Whistleblowers Serving Justice

Earlier this year, the Department of Health and Human Services released the results of a four-year-long survey of 4,563 hospice facilities nationwide. The study, which ran from 2012 to 2016, included nearly every hospice center that serviced Medicare patients. It was the most in-depth study of its kind ever conducted. 

The results were astounding: One in ten of the facilities were ‘poor’ performers, constituting serious endangerment, and more than 80 percent of them had at least one deficiency. More than 300 of the centers exhibited life-threatening conditions. 

Complaints ranged from signs of sexual assault that went ignored to feeding tubes that were allowed to develop maggots. In one case, a patient’s wounds were improperly treated, which ultimately resulted in the patient’s leg having to be amputated. 

The takeaway from the reports is clear. A significant share of hospice centers all around the country have been ignoring Medicare’s standards of care and actively harming the patients in their care -- an especially susceptible population of people who are entrusting these facilities with their end-of-life care. 

And, these hospice centers are using government funding to do it.  

The worst revelation to come out of these reports is that the grave mistreatment they document isn’t new. Hospice providers have a long history of abuse, and they’ve been on the receiving end of multiple whistleblower reports. 

What you might not know: whistleblower accounts are a critical way that we hold corporations like hospices accountable. And whistleblowers need lawyers, too.

It all comes back to the False Claims Act, which was passed in the US during the Lincoln administration. The act hinges on the idea that the government picks up the tab for all sorts of things: military supplies, government services like social security… the list goes on. The False Claims Act is there to make sure the government isn’t getting cheated out of money in the process. 

Let’s go back to Medicare. A reminder here: that’s the government program that provides healthcare services to older individuals and a few others. Even though the government is providing the services – well, people still have to get paid. So, when it comes time to settle up, the different players in that system – the doctors, the hospitals, the pharmacies – send the bill to the government. The itemized receipts can include anything from emergency room visits to hospice care. 

But what happens when someone is, say, inflating the numbers so they get a bigger payout? Or billing the government for doctor’s visits that never happened? Or neglecting patients to the extent that maggots can develop in their feeding tubes, like at the hospice in the study? That’s exactly where the False Claims Act comes in. 

Here’s how it works: The act says that anyone who has true insider knowledge of a person or entity cheating on their government billing can file a “whistleblower” lawsuit against them: People of the United States vs. that cheating person or entity. It’s kind of like a reward system for people to stick up for the government -- and for the people these government programs serve. If they win the suit, the whistleblower typically takes home 15 to 30 percent of the damages. 

You might be wondering: if the abuses in the hospice care system were so egregious, and there’s this entire system in place to reward whistleblowers, why didn’t more people do it? The short answer is that people are afraid. Many employees are afraid to speak up because of the possibility of retaliation at work -- and they might not know that retaliation is illegal. What’s more, most people have no idea that the False Claims Act even exists to protect them. 

Horrifying situations in hospice care networks have been overlooked too often, and for too long. If you’ve witnessed fraud in hospice care, it’s critical that you speak up. Please contact us if you have information about abuse in hospice centers.


David Kani

David Kani is a Southern California based trial lawyer with a focus on whistleblower (False Claims Act, SEC and others) cases.

To learn more about David: davidkani.com

Read David's ebook: The Smart Whistleblower's Playbook
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