ATTORNEY NEWSLETTER
Allegedly Billed For Hospice Case For Patients Not Terminally Ill
Former Employee Blew Whistle
How Qui Tam Cases Work
Healthcare providers in the U.S., including hospice service providers, sellers of medical products and devices, hospitals and clinics, are all subject to a number of statutes to prevent any fraudulent billing under government programs like Medicare and Medicaid. When the providers violate federal healthcare laws such as eligibility guidelines, they also violate the False Claims Act (“FCA”), 31 U.S.C. §§ 3729-3733, for submitting false claims for payment to the government. One of the underlying protections against fraud in the healthcare field is individuals with information about this kind of scheme can be rewarded for bringing this kind of illegal practice to light. 31 U.S.C. § 3730(b). The California whistleblower attorneys at Evans Law Firm, Inc. represents individuals who bring FCA cases based for any kind of fraud against Medicare or Medicaid or other government-sponsored healthcare programs. If you have credible, original information of healthcare fraud in Santa Clara County, elsewhere in the South Bay or anywhere in Northern California, call us today at (415)441-8669 or toll-free at (888)-50EVANS (503-8267) and we can help.
Recent FCA Case Settlement*
According to a recent U.S. Department of Justice (DOJ) press release, a hospice care provider has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by knowingly submitting false claims for the care of hospice patients who were ineligible for the Medicare hospice benefit because they were not terminally ill. Hospice care is special, end-of-life care intended to comfort terminally ill patients. Patients admitted to hospice care generally stop receiving traditional medical care designed to cure their terminal condition and instead receive medical care focused on providing them with relief from the symptoms, pain, and stress of a terminal illness. Medicare patients are considered to be terminally ill and hospice-eligible when they have a life expectancy of six months or less if their illness runs its normal course.
“Respectful and appropriate end-of-life care is the crux of the hospice benefit under Medicare,” said Principal Deputy Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “The Department will hold accountable those who exploit this benefit for their own gain.” The settlement resolves allegations filed by a former employee, who will receive a share of the settlement.
How False Claims Act Whistleblower Cases Work
Cases such as this one are often initiated under the qui tam, or whistleblower, provisions of the FCA. 31 U.S.C. § 3730(b). The FCA allows private parties to sue on behalf of the government for false claims, and to receive a share of any recovery. 31 U.S.C. § 3730(b) (procedures for initiating qui tam actions). The suit is filed confidentially and remains under seal giving the government time to review the allegations in the case. If the government decides to intervene, the government essentially takes over the case. If the government declines to intervene, the plaintiff has the right to continue the suit of their own. The whistleblowers stand to receive up to 15-30% of the settlement in accordance with 31 U.S.C. § 3730(d)(1) and (2).
Contact Us
If you have information of healthcare fraud against the federal government or the State of California occurring in Santa Clara County or elsewhere in the State, contact Ingrid M. Evans at Evans Law Firm at (415) 441-8669, or toll-free at (888)-50EVANS (503-8267) or by email at <a href=”mailto:info@evanslaw.com”>info@evanslaw.com</a>. In addition to False Claims cases, Ingrid also represents individual whistleblowers in qui tam cases involving bank fraud under FIRREA/FIAFEA, commodity trading and securities fraud under the Commodities Futures Trading Commission Whistleblower Program and the Securities and Exchange Commission Whistleblower Program, and tax fraud under the Internal Revenue Service Whistleblower Program.
- Evans Law Firm, Inc. was not involved in the reported case in any way.
