Anti-kickback and fraud cases have proliferated as regulators zero in on the hospice industry. How a hospice works with referral sources can be a red flag that brings providers face-to-face with criminal charges in False Claims Act (FCA) cases.
FCA suits can include significant legal repercussions for hospice providers such as imprisonment for committing health care fraud. In some cases, hospice leaders have been arrested for their roles, received several years or decades of prison sentences, or they have been barred from practicing all together.
Criminal FCA cases often involve issues related to kickback schemes in which hospices billed Medicare for services that patients either weren’t eligible for, or never received.
Patient referral streams can be at the core of kickback concerns that lead to criminal charges in fraud cases, according to Jennifer Weaver, attorney at health care law firm Waller and co-chair of its health care industry team.
“A typical False Claims Act case would be a medical necessity and eligibility dispute. When you see it escalate to criminal cases, most involve kickbacks,” Weaver told Hospice News. “That would be where a hospice is essentially paying for patient referrals just to sign people up for hospice and then not providing care, or it being conceived that way. The government is always very attuned to kickbacks cases. These are easier to financially prove, as opposed to medical necessity or eligibility, which are harder because they involve...
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