July 13, 2020 – Fort Myers, Florida – – Florida-based Hope Hospice has agreed to pay $3.2 million to resolve a whistleblower lawsuit alleging the company knowingly submitted false claims to government healthcare agencies for hospice care provided to beneficiaries who did not qualify for the services.
The settlement resolves hospice fraud allegations initially raised by Margaret Peters, who once worked at Hope Hospice as its Director of Hospice Care. In her whistleblower lawsuit, Ms. Peters alleged that Hope Hospice for years submitted false claims to Medicare, Medicaid, and TRICARE for hospice services provided to patients who were not terminally ill. The complaint also alleged the company submitted for reimbursement for hospice services under circumstances in which the level of care was not medically necessary.
Whistleblower attorneys Mark H. Schlein from the law firm of Baum Hedlund Aristei & Goldman represented Ms. Peters in her case against Hope Hospice.
“Many of our loved ones will turn to hospice for compassionate end of life care,” says veteran whistleblower attorney Mark Schlein. “They are among our most vulnerable citizens and deserve the best care possible. Fortunately, hospice workers are among the most dedicated and caring health care providers. Unfortunately, some hospice companies abuse the limited dollars provided for this critical care. When this happens, the government frequently relies on the courage of hospice professionals to step forward and blow the whistle on this fraud and abuse. Blowing the whistle is never easy, but these brave Relators know it is something they must do. We owe them all a debt of gratitude and I’m proud to have represented the whistleblower in this case.”
“Ms. Peters showed tremendous courage and integrity by coming forward and bringing these allegations to the government’s attention,” says whistleblower attorney Mark Schlein. “Her advocacy for the patients unwittingly caught up in this matter and for the American taxpayer deserves our appreciation and gratitude. Because of her willingness to stop this provider’s misconduct, many more deserving patients will be able to obtain hospice care.”
Allegations in Hope Hospice Whistleblower Lawsuit
Hospice care is palliative health care for patients who are going through life-limiting illnesses. It is a special kind of care for patients who have generally stopped seeking curative treatment and are instead in need of relief from pain and stress that comes at the end of life. Medicare beneficiaries are eligible for hospice care if they have a life expectancy of six months or less to live.
This settlement resolves allegations initially raised by Ms. Peters alleging that Hope Hospice knowingly submitted claims for hospice care provided to patients who were not terminally ill. According to the whistleblower lawsuit, Hope Hospice billed Medicare for hospice care provided to patients who were not terminally ill. In some cases, Hope Hospice submitted claims for patients at various times over the course of four or more years.
Medicare, Medicaid and, TRICARE reimburse health care providers for four different level of hospice care:
- Routine home care
- Continuous home care
- Inpatient respite care
- General inpatient care
General inpatient care is pain control or symptom management for patients that cannot receive such care in their home. It is supposed to be short-term and is reimbursed at a higher rate than any other levels of care.
According to Ms. Peters’ whistleblower lawsuit, Hope Hospice knowingly submitted false claims to government healthcare agencies for general inpatient hospice care under circumstances in which that level of care was not necessary.
Whistleblower provisions under the federal False Claims Act allow for private citizens with unique knowledge of fraud to sue on the government’s behalf to recover any money obtained via false claims. The government may choose to intervene in the lawsuit and prosecute the action based on the whistleblower’s allegations. If the claim leads to a successful enforcement action and money is recovered, the whistleblower may be eligible to share in the recovery.
The government decided to intervene in Ms. Peters’ case (U.S. and the State of Florida ex rel. Margaret Peters v. Hope Hospice and Community Services, et al, No. 2:16-cv-6-FtM-99MRM), and a subsequent investigation was handled by the Fort Myers Division of the U.S. Attorney’s Office for the Middle District of Florida and Trial Attorney Holly H. Snow from the Civil Division’s Commercial Litigation Branch, with assistance from the U.S. Department of Health and Human Services – Office of Inspector General, Defense Criminal Investigative Service, and the State of Florida Medicaid Fraud Control Unit Civil Enforcement Bureau.
As a reward for filing the whistleblower lawsuit, Ms. Peters will receive a whistleblower reward of 19% of the total recovery – more than $600,000.
In addition to the $3.2 million settlement, Hope Hospice agreed to enter into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services – Office of Inspector General. The agreement promotes compliance with statutes, program requirements, regulations, and written directives from government healthcare agencies.
About Baum Hedlund Aristei & Goldman
The whistleblower lawyers at Baum Hedlund Aristei & Goldman have secured settlements against major aircraft manufacturers, commercial transportation companies, pharmaceutical companies, doctors offices, and medical device manufacturers. These settlements not only resulted in millions of dollars recovered on the government’s behalf and just compensation to our whistleblower clients, but also exposed harmful industry practices and deceptive marketing schemes.
In practice since 1973, the firm has won more than $4 billion in verdicts and settlements on behalf of clients across all areas of practice.