The U.S. Attorney's Office for the Eastern District of Kentucky and the Department of Health and Human Services Office of Inspector General announced that Hospice of the Bluegrass, Inc., located in Lexington, agreed to pay the U.S. Government hundreds of thousands of dollars to settle civil allegations.
According to the settlement agreement, from January 2002 to December 31 2008, Hospice submitted numerous claims to Medicare to receive reimbursements for services performed on patients who did not qualify for the Medicare services. Hospice agreed to pay the U.S. Government $685,000 to settle the allegations.
"This settlement returns a significant amount of funds back to the Medicare trust fund that should have never been paid out," said U.S. Attorney Kerry B. Harvey.
Five Hospice employees previously filed a lawsuit against the company claiming that Hospice improperly billed for Medicare services. The suit was filed using the qui tam provision of the False Claims Act, informally known as "whistleblowing." The False Claims Act is a federal law that allows individuals to file lawsuits against anyone who defrauds U.S. Government programs. If the government receives money as a result of the
whistleblower's lawsuit then the plaintiff(s) (the whistleblower) may receive a portion of the recovered money. In this case, the employees will receive $137,000 of the recovered money.
The investigation was conducted by the Office of Inspector General for the Department of Health and Human Services and the U.S. Attorney's Office. Assistant U.S. Attorney Andrew Sparks handled the litigation for the U.S. in this case.
Hospice of the Bluegrass issued the following statement from Vice President of Compliance and Quality Eugenia Smither:
“The United States Department of Justice announced the settlement of a case involving Hospice of the Bluegrass. The issue focused upon the physicians’ determination of the life expectancy and length of stay of terminally ill patients who received care nearly a decade ago. Making decisions about how long patients are expected to live is complex, especially for patients who suffer from non-cancer terminal diseases like heart and lung disease. Ninety percent of Hospice of the Bluegrass patients die within six months of admission, almost all patients die within one year; only a small percentage of very ill patients survive more than one year.
“Physicians who specialize in Hospice and Palliative Medicine disagree with government reviewers about the eligibility for hospice care of this small number of non-cancer patients. However, Hospice of the Bluegrass chose to settle after carefully considering the resources and time that would be necessary to litigate the issues in order to focus on providing high quality, compassionate hospice care for dying patients and their families.”